1. education

FACTORS CONTRIBUTING TO HIGH ADOLESCENT PREGNANCY RATE IN
KINONDONI MUNICIPALITY, DAR-ES-SALAAM, TANZANIA
by
MARGARETH NKUBA PHILEMON
Submitted in partial fulfilment of the requirements
for the degree of
MASTER OF ARTS
in the subject
HEALTH STUDIES
at the
UNIVERSITY OF SOUTH AFRICA
SUPERVISOR: MRS JE TJALLINKS
JOINT SUPERVISOR: DR MLM SENGANE
NOVEMBER 2007
Student number: 3428-779-5
DECLARATION
I declare that FACTORS CONTRIBUTING TO HIGH ADOLESCENT PREGNANCY RATE IN
KINONDONI MUNICIAPLITY, DAR-ES-SALAAM, TANZANIA is my own work and that all the
sources that I have used or quoted have been indicated and acknowledged by means of complete
references and that this work has not been submitted before for any other degree at any other
institution.
SIGNATURE
(Margareth Nkuba Philemon)
DATE …………………………
FACTORS CONTRIBUTING TO HIGH ADOLESCENT PREGNANCY RATE IN KINONDONI
MUNICIPALITY, DAR-ES-SALAAM, TANZANIA
STUDENT NUMBER:
STUDENT:
DEGREE:
DEPARTMENT:
SUPERVISOR:
JOINT SUPERVISOR:
3428-779-5
MARGARETH NKUBA PHILEMON
MASTER OF ARTS
HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA
MRS JE TJALLINKS
DR MLM SENGANE
ABSTRACT
This study seeks to describe the factors contributing to high adolescent pregnancy rate in
Kinondoni Municipality, Dar-es-Salaam. Through the study we get to know the social economic
characteristics of adolescents, the adolescents’ general knowledge of reproductive health issues
and the source of this knowledge.
The major discoveries made from this study are that the educational status and knowledge of
reproductive health of these adolescents is low, some are already dropouts from school, and others
were deprived of the chance to continue with secondary education. They have nothing tangible to
do because of their low education and coupled with their low economic status, they are at risk of
being involved in sexual activities at an early age, ending in pregnancies. In addition, their parents’
educational and economic status was also found to be low.
It is important then, parents, teachers and the community in general to arrest the rate of adolescent
pregnancies.
KEY TERMS
Adolescent pregnancy; reproductive health issues; sexuality.
ACKNOWLEDGEMENTS
There is a saying that no feast comes to the table on its own feet, and so it is with this dissertation.
Therefore, I wish to express my thanks and appreciation to the following:
•
First, my thanks and praise to God for the strength and health to complete this study
•
Ms JE Tjallinks and Dr MLM Sengane, my supervisors at Unisa, for their guidance,
encouragement, and everything they taught me
•
Muhimbili University College of Health Sciences and Kinondoni Municipal Council, for
permission to conduct the study in Manzese Ward.
•
My family (especially my husband Charles, son Elineema, and daughters NapeMercy and
RuthShigongo) and my friends, for encouraging, supporting and believing in me
•
Mrs Talana Erasmus, Unisa librarian, for her patience and assistance with the literature
sources
•
Mr Mayunga and Candida Moshiro, for the statistical analysis and interpretation
•
Ms Rina Coetzer, for her professional and patient finalising of the dissertation
•
Ms Iauma Cooper, for critically and professionally editing the manuscript
To all, my sincere thanks and love and I wish you strength in your endeavours – may people be as
caring and helpful to you as you have been to me.
i
Table of contents
Page
Chapter 1
Orientation to the study
1.1
INTRODUCTION ......................................................................................................................................... 1
1.2
BACKGROUND TO THE STUDY................................................................................................................. 2
1.2.1
Tanzania....................................................................................................................................................... 2
1.2.1.1
1.2.1.2
1.2.1.3
1.2.1.4
1.2.1.5
1.2.1.6
Country profile .............................................................................................................................................. 2
Social-economic condition............................................................................................................................ 2
Education system ......................................................................................................................................... 3
Health care services ..................................................................................................................................... 3
Religion......................................................................................................................................................... 4
Administration............................................................................................................................................... 4
1.2.2
1.2.3
Adolescent pregnancies ............................................................................................................................... 5
Adolescent girls residing in Kinondoni Municipality ...................................................................................... 7
1.3
PROBLEM STATEMENT ............................................................................................................................. 9
1.4
PURPOSE OF THE STUDY......................................................................................................................... 9
1.5
OBJECTIVES ............................................................................................................................................. 10
1.6
RESEARCH DESIGN AND METHODOLOGY ........................................................................................... 10
1.6.1
1.6.2
1.6.3
1.6.4
1.6.5
1.6.6
1.6.7
1.6.8
Research design......................................................................................................................................... 10
Setting ........................................................................................................................................................ 10
Population and sampling ............................................................................................................................ 11
Sampling..................................................................................................................................................... 11
Data collection ............................................................................................................................................ 11
Data analysis .............................................................................................................................................. 11
Reliability and validity ................................................................................................................................. 11
Pre-test (pilot study) ................................................................................................................................... 12
1.7
ETHICAL CONSIDERTIONS...................................................................................................................... 12
1.8
SIGNIFICANCE OF THE STUDY............................................................................................................... 12
1.9
DEFINITION OF KEY TERMS.................................................................................................................... 14
1.10
LIST OF ABBREVIATIONS ........................................................................................................................ 16
1.11
OUTLINE OF THE STUDY......................................................................................................................... 17
1.12
CONCLUSION............................................................................................................................................ 17
ii
Table of contents
Page
Chapter 2
Literature review
2.1
INTRODUCTION ........................................................................................................................................ 18
2.2
REASONS FOR A LITERATURE REVIEW................................................................................................ 18
2.3
ADOLESCENCE ........................................................................................................................................ 18
2.3.1
Definition..................................................................................................................................................... 18
2.3.2
Adolescent identity ..................................................................................................................................... 19
2.3.3
Developmental stages of the adolescent.................................................................................................... 19
2.3.3.1
2.3.3.2
Piaget’s stages of cognitive development................................................................................................... 19
Erickson’s psychosocial stages of development......................................................................................... 19
2.3.4
Physiological and psychosocial development of the adolescent girl........................................................... 20
2.4
FACTORS CONTRIBUTING TO ADOLESCENT PREGNANCY ............................................................... 20
2.4.1
2.4.2
2.4.3
2.4.4
2.4.5
2.4.6
2.4.7
Early menarche .......................................................................................................................................... 21
Adolescent sexual behaviour...................................................................................................................... 21
Socio-cultural and economic factors........................................................................................................... 22
Educational status ...................................................................................................................................... 23
Sexual violence .......................................................................................................................................... 23
Peer pressure ............................................................................................................................................. 24
Urbanisation ............................................................................................................................................... 25
2.5
REPRODUCTIVE HEALTH SERVICES TO ADOLESCENTS ................................................................... 25
2.5.1
2.5.2
2.5.3
Types of reproductive health services ........................................................................................................ 25
Contraception ............................................................................................................................................. 26
Life skills education .................................................................................................................................... 27
2.6
SUPPORTIVE ENVIRONMENT TO THE ADOLESCENT GIRL ................................................................ 28
2.6.1
2.6.2
2.6.3
2.6.4
2.6.5
2.6.6
Parents ....................................................................................................................................................... 28
Community/religion..................................................................................................................................... 29
School......................................................................................................................................................... 29
Cultural support .......................................................................................................................................... 30
Health providers and governments............................................................................................................. 30
Adolescent involvement and peer influence ............................................................................................... 31
2.7
EDUCATION AND COMMUNICATION...................................................................................................... 32
2.7.1
2.7.2
Education is power ..................................................................................................................................... 32
Knowledge of adolescents’ on reproductive health issues ......................................................................... 32
iii
Table of contents
Page
2.8
THE EFFECTS OF PREGNANCY ON THE ADOLESCENT GIRL ............................................................ 33
2.8.1
2.8.2
2.8.3
2.8.4
2.8.5
2.8.6
Interruption of schooling ............................................................................................................................. 33
Gender education ....................................................................................................................................... 34
Sexual transmitted diseases....................................................................................................................... 34
Abortion ...................................................................................................................................................... 34
Complications during pregnancy and delivery ............................................................................................ 35
Other factors............................................................................................................................................... 35
2.10
CONCLUSION............................................................................................................................................ 35
Chapter 3
Research design and methodology
3.1
INTRODUCTION ........................................................................................................................................ 36
3.2
PURPOSE OF THE STUDY....................................................................................................................... 36
3.3
RESEARCH SETTING ............................................................................................................................... 36
3.4
RESEARCH DESIGN................................................................................................................................. 37
3.4.1
3.4.2
3.4.3
3.4.4
Quantitative research ................................................................................................................................. 37
Exploratory descriptive design.................................................................................................................... 38
Descriptive.................................................................................................................................................. 39
Exploratory descriptive research design..................................................................................................... 39
3.5
RESEARCH POPULATION AND SAMPLE ............................................................................................... 39
3.5.1
3.5.2
Population................................................................................................................................................... 40
Sampling and sample ................................................................................................................................. 40
3.5.2.1
3.5.2.2
Sampling techniques .................................................................................................................................. 40
Sample size ................................................................................................................................................ 40
3.6
DATA COLLECTION .................................................................................................................................. 41
3.6.1
Data-collection instrument .......................................................................................................................... 41
3.6.1.1
3.6.1.2
3.6.1.3
3.6.1.4
3.6.1.5
Characteristics of a questionnaire .............................................................................................................. 42
Development of the questionnaire .............................................................................................................. 42
Structure of the questionnaire..................................................................................................................... 43
Administration of the questionnaire ............................................................................................................ 43
Advantages of a questionnaire ................................................................................................................... 44
3.6.2
Reliability and validity ................................................................................................................................. 44
3.6.2.1
3.6.2.2
Reliability .................................................................................................................................................... 44
Validity ........................................................................................................................................................ 45
iv
Table of contents
Page
3.7
ETHICAL CONSIDEATIONS...................................................................................................................... 45
3.7.1
3.7.2
3.7.3
3.7.4
3.7.5
3.7.6
3.7.7
Beneficence................................................................................................................................................ 46
Respect for human dignity.......................................................................................................................... 46
Self-respect ................................................................................................................................................ 47
Benefit ........................................................................................................................................................ 47
Protection of human rights.......................................................................................................................... 47
Fair treatment ............................................................................................................................................. 47
Data processing.......................................................................................................................................... 47
3.8
PRETESTING THE RESEARCH INSTRUMENT ....................................................................................... 48
3.9
DATA ANALYSIS ....................................................................................................................................... 48
3.10
CONCLUSION............................................................................................................................................ 48
Chapter 4
Data analysis and interpretation
4.1
INTRODUCTION ........................................................................................................................................ 49
4.2
SECTION A: BIOGRAPHICAL INFORMATION ......................................................................................... 50
4.2.1
4.2.2
4.2.3
4.2.4
4.2.5
4.2.6
4.2.7
Item 1:
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
4.3
SECTION B: SEXUALITY AND REPRODUCTIVE HEALTH ISSUES ...................................................... 57
4.3.1
4.3.2
4.3.3
4.3.4
Item 8: Respondents’ age at first menstrual period (menarche) ................................................................ 57
Item 9: Respondents’ age at first sexual encounter (debut) ...................................................................... 58
Item 10: Respondents’ reasons of sexual debut........................................................................................ 59
Item 11: Respondents’ pregnancy ............................................................................................................. 61
4.3.4.1
4.3.4.2
Item 11.1: Age at first pregnancy............................................................................................................... 61
Item 11.2: Pregnancies planned or unplanned .......................................................................................... 62
4.3.5
Item 12: Respondents’ information about abortion .................................................................................... 62
4.3.5.1
4.3.5.2
Item 12.1: Respondents who had an abortion ........................................................................................... 62
Item 12.2: Where abortion was conducted ................................................................................................ 62
4.3.5.3
Item 12.3 Should girls aged 10-19 have a legal abortion or not ................................................................ 63
4.3.6
Item 13: Respondents’ knowledge on reproductive health issues ............................................................. 63
4.3.6.1
Item 13.1: When is a woman likely to fall pregnant.................................................................................... 63
Respondents’ age.......................................................................................................................... 50
Respondents’ religion .................................................................................................................... 51
Respondents’ educational level ..................................................................................................... 51
Respondents’ occupational status ................................................................................................. 52
Respondents’ marital status .......................................................................................................... 54
Who respondents live with............................................................................................................. 54
Respondents’ parents/guardians educational and economic status.............................................. 55
v
Table of contents
Page
4.3.6.2
4.3.6.3
4.3.6.4
4.3.6.5
4.3.6.6
4.3.6.7
4.3.6.8
Item 13.2: Risk age for an adolescent to pregnant ................................................................................... 64
Item 13:3 Appropriate age for an adolescent to fall pregnant .................................................................... 64
Item 13.4: Right time for a girl to receive information about reproductive health issues............................ 64
Item 13.5: Respondents’ knowledge on contraception .............................................................................. 65
Item 13.6: Suitable contraceptive methods for adolescents ...................................................................... 66
Item 13.7: Methods that prevent pregnancy and STDs ............................................................................. 66
Item 13.8: How to prevent pregnancy, STDs and HIV ............................................................................... 67
4.4
SECTION C: SOURCE OF INFORMATION.............................................................................................. 67
4.4.1
4.4.2
4.4.3
Item 14: Respondents’ source of information regarding menstruation ...................................................... 67
Item 15: Respondents’ source of information about sexuality and reproduction ....................................... 68
Item 16: Respondents’ source of knowledge about pregnancy ................................................................. 69
4.5
SECTION D: EFFECTS OF PREGNANCY ON ADOLESCENT ............................................................... 70
4.5.1
4.5.2
Item 17: Respondents’ knowledge of the effects of pregnancy on the adolescent .................................... 70
Item 18: What the respondents would like to learn more about................................................................. 72
4.6
CONCLUSION............................................................................................................................................ 72
Chapter 5
Findings, limitations and recommendations
5.1
INTRODUCTION ........................................................................................................................................ 73
5.2
FINDINGS .................................................................................................................................................. 73
5.2.1
5.2.2
5.2.3
5.2.4
5.2.5
5.2.6
5.2.7
5.2.8
5.2.9
5.2.10
5.2.11
5.2.12
5.2.13
5.2.14
5.2.15
5.2.16
Age ............................................................................................................................................................. 73
Religion....................................................................................................................................................... 73
Educational level ........................................................................................................................................ 73
Occupational status .................................................................................................................................... 74
Marital status .............................................................................................................................................. 74
Who living with............................................................................................................................................ 74
Parents/guardians’ educational and economic status ................................................................................ 75
Age at first menstrual period....................................................................................................................... 75
Age at first sexual encounter ...................................................................................................................... 75
Reasons for sexual debut........................................................................................................................... 75
Pregnancy .................................................................................................................................................. 76
Abortion ...................................................................................................................................................... 76
Knowledge of reproductive issues .............................................................................................................. 76
Source of knowledge of reproductive issues .............................................................................................. 77
Knowledge of effects of pregnancies on adolescents................................................................................. 78
What the respondents wanted to know more about ................................................................................... 78
5.3
LIMITATIONS OF THE STUDY.................................................................................................................. 79
vi
Table of contents
Page
5.4
RECOMMENDATIONS .............................................................................................................................. 79
5.4.1
5.4.2
5.4.3
5.4.4
5.4.5
Ministry of Education and vocational training ............................................................................................. 79
Community support system ........................................................................................................................ 80
Health services management ..................................................................................................................... 80
The country................................................................................................................................................. 80
Further research ......................................................................................................................................... 81
5.5
CONCLUSION............................................................................................................................................ 81
BIBLIOGRAPHY.......................................................................................................................................................... 82
vii
List of tables
Page
Table 1.1
Health facilities in Tanzania, 2000.................................................................................................. 4
Table 1.2
Pregnant adolescents attending antenatal clinic at Magomeni Health Centre ............................... 8
Table 4.1
Respondents’ educational level (n=202) .......................................................................................51
Table 4.2
Respondents’ occupation (n=203).................................................................................................53
Table 4.3
Who rspondents live with (n=203) .................................................................................................54
Table 4.4
Respondents’ fathers’ level of education (n=149) .........................................................................55
Table 4.5
Respondents’ mothers’ level of education (n=157) .......................................................................55
Table 4.6
Respondents’ guardians’ level of education (n=24).......................................................................56
Table 4.7
Respondents’ fathers’ occupational status (n=183).......................................................................56
Table 4.8
Respondents’ mothers’ occupational status (n=186).....................................................................56
Table 4.9
Respondents’ age at first sexual encounter (n=58).......................................................................59
Table 4.10
Respondents’ reasons of sexual debut (n=58)..............................................................................60
Table 4.11
Respondents’ recommendations on when to receive reproductive health information (n=203) ....64
Table 4.12
Respondents’ use of contraceptives (n=22) ..................................................................................66
Table 4.13
Respondents’ source of information on sexuality and reproduction (n=203).................................69
Table 4.14
Respondents’ source of information about pregnancy (n=203).....................................................69
viii
List of figures
Page
Figure 1.1
Map of Tanzania .................................................................................................................................. 5
Figure 4.1
Respondents’ age (n=203)................................................................................................................. 50
Figure 4.2
Respondents’ age at menarche (n=144)............................................................................................ 58
Figure 4.3
Respondents’ age at first pregnancy (n=21) ...................................................................................... 61
Figure 4.4
Respondents’ source of knowledge regarding menstruation.............................................................. 68
Figure 4.5
Respondents’ knowledge of effects of pregnancy on adolescents (n=203) ....................................... 71
ix
List of annexures
Annexure A
Letters requesting permission to the study:
1
District Medical Officer
Kinondoni Municipal Council, Dar es Salaam, Tanzania
2
Chairman, College of Research and Publications Committee
Muhimbili University College Health Sciences
Annexure B
Letters granting permission to conduct the study:
1
Department of Health Studies, Unisa
2
Chairman, College of Research and Publications Committee
Muhimbili University College Health Sciences
3
Municipal Medical Officer
Kinondoni Municipal Council, Dar-es-Salaam, Tanzania
Annexure C
Consent forms:
1
English form
2
Kiswahili form
Annexure D
Questionnaires:
1
English questionnaire
2
Kiswahili questionnaire
Chapter 1
Orientation to the study
1.1
INTRODUCTION
Early childbearing, particularly among teenagers (those under 20 years of age) has
negative demographic, socio-economic and socio-cultural consequences. Teenage
mothers are likely to suffer from severe complications during delivery, which result in
higher morbidity and mortality for them and their children. In addition, the socioeconomic advancement of teenage mothers in the areas of education and accessibility
to job opportunities may be curtailed. The National Bureau of Statistics [NBS] (2000:37)
reported that in Tanzania the median age at first intercourse for women is just under 17.
About 15% of women aged 15-19 have had sexual intercourse for the first time by the
age of 15. By the age of 15, 18,65% of women are already sexually active and by 20,
about 86% are sexually active (NBS 2000:67-68).
According to Marlow and Redding (2001:1127), puberty and adolescence are the
periods during which there is a great surge of genital development. The secondary
sexual characteristics appear, which increases sexual tension. The sex drive is
triggered by certain androgens such as testosterone, which are at a higher level during
adolescence than at any other time of life. Children entering adolescence are not fully
sexually matured, yet they are capable of reproduction.
The consequences of indulging in sexual activity at an early age include adolescent
pregnancies, unsafe abortion, sexually transmitted diseases (STDs), HIV/AIDS, and
anaemia (Reproductive and Child Health Section [RCHS] 2004a:3-6). Ojo, Ajay, Garba
and Ngoran (2004:35) emphasised that the optimal childbearing years are between 18
and 35 years. This age range is recommended because scientifically the girl’s body is
mature and she should be psychologically ready for childbearing and its consequences.
Given the above consequences, adolescent girls need information on biological
changes, sexual issues and reproductive health services. In addition, they need
guidance from parents, teachers and health providers, which is crucial in order to
1
achieve their full potential (Sadock & Sadock 2003:35). In Africa, adolescents are a low
priority in both policies and programmes at national level (Williams & Mavundla
1999:62).
1.2
BACKGROUND TO THE STUDY
Adolescent pregnancy is a worldwide problem. In 1997, Grunseit (1997:12) found that
the USA had the highest rate of adolescent pregnancies. In addition, every year more
teenage girls become pregnant, many younger than 17 years old.
1.2.1 Tanzania
1.2.1.1
Country profile
The United Republic of Tanzania is the largest country in East Africa, covering a total
area of 945,090 square kilometres, with a population of 35 million (NBS 2000:37).
According to the Population and Housing Census, 2002, about 65% of the population
were under 25 years of age. Those aged 10-24 years constitute 31%. Women aged 1519 account for 12% of the total fertility rate (TFR) which is 5.6 per woman (NBS
2003:23; RCHS 2004a:1).
1.2.1.2
Socio-economic condition
Tanzania is a poor country with about 51% of the population living in poverty, many of
whom cannot afford their basic daily life requirements. There are very limited formal
employment opportunities, particularly for youth and especially girls. Adolescents are
growing up in an economy that is not able to fulfil their expectations. Inadequate health
care services and economic hardship have led to the increase of adolescent high risk
situations such as unwanted pregnancies and early child bearing, STIs, including
HIV/AIDS, and drug abuse (RCHS 2004a:1).
2
1.2.1.3
Education system
According to the Education and Training Policy (Ministry of Education and Culture
1995:18), pre-primary and primary education is a basic right for all citizens. The Ministry
of Education and Culture, the Ministry of Science Technology and Higher Education,
and the Prime Minister’s office are mainly responsible for formal and non-formal
education. Other ministries are involved in sector-specific professional education and
training. In addition, communities, non-governmental organisations (NGOs) and
individuals provide formal and non-formal education with the coordination of central
government ministries (Ministry of Education and Culture 1995:11).
The education system in Tanzania caters for pre-primary (2 years), primary (7 years),
Ordinary level secondary education (O-level) (4 years), Advanced level secondary
education (A-level) (2 years) and university (tertiary) education (3+ years). Children start
pre-primary education at the age of 5 and complete primary education at the age of 13
years. With a transition rate of less than 50%, the majority of primary school graduates
are not well taken care of. Being adolescents who are at the reproductive age, cases of
pregnancies are common. Most of the pregnancies occur in young girls between
Standards 4 and 7 (Grades 6-8), and 5% to 7% of dropouts at primary level are due to
pregnancy (Ministry of Education and Culture 2005:21-25).
1.2.1.4
Health care services
The provision of health care services is divided into three levels: national, regional and
district. At the national level, the Ministry of Health administers and supervises
consultant referral hospitals, training institutions, the national hospitals, special
hospitals, executive agencies and regulatory authorities. At the regional level, provision
of health services is vested with the Regional Administrative Secretary with technical
guidance
of
Regional
Health
Management
Team.
District
management
and
administration of health care services has been developed into districts through their
respective councils, local authorities, health service boards, facility committees and
health management teams (Ministry of Health [MOH] 2002:1). More than 70% of the
population lives in rural areas, so the distribution of health facilities has rural emphasis.
Table 1.1 indicates the health facilities in 2000.
3
Table 1.1
Health facilities in Tanzania, 2000
Facility
Govt
Consultancy/Specialised
Hospitals
Regional Hospitals
District Hospitals
Other Hospitals
Health Centres
Dispensaries
Specialised Clinics
4
17
55
2
409
2450
75
Parastatal
2
Agency
Vol/Rel
2
0
0
6
6
202
0
0
13
56
48
612
4
Private
0
Others
-
0
0
20
16
663
22
2
28
-
Source: NBS 2000:43
1.2.1.5
Religion
In mainland Tanzania, the main religions are Christianity (45%), Islam (Muslims) (35%)
and indigenous beliefs (20%). In Zanzibar the vast majority are Muslims.
1.2.1.6
Administration
Administratively, the mainland is divided into 21 regions, and each region is subdivided
into districts/municipalities. Dar-es-Salaam region comprises three municipalities,
namely Kinondoni, ILala, and Temeke. Kinondoni is highly populated in comparison to
the other two municipalities (see figure 1.1).
4
Figure 1.1
Map of Tanzania
(http://www.tanzaniagov.org.tz)
1.2.2 Adolescent pregnancies
The number of adolescent pregnancies continues to rise in Tanzania. For example, in
2006, among the dropouts, 3,479 in primary school and 993 in secondary school were
due to pregnancy alone (Ministry of Education and Vocational Training [MOE and VT]
5
2006c:17). Accessibility to healthcare is influenced by health workers’ attitudes, which
might be intimidating to some adolescents at specific clinics and schools (Little
1997:44).
Tanzania, like many countries in Africa and elsewhere, has serious problems in relation
to sexual and reproductive health issues (RCHS 2004:3; Irinoye, Oyeleye, Adeyemi &
Tope-Ojo 2004:25). In their study on high-risk sexual behaviour among youth at
Kisangani Ward in Tanga, Ikamba and Quedraogo (2003:121) found that adolescents
were sexually active at an early age. Furthermore, 0.3% of the girls and 3.2% of the
boys had their first intercourse at about 9 years old, the percentage rose to 10 by the
age of 13 years. The largest group (55% of the girls and 45% of the boys) had their first
sexual intercourse between 14 and 17 years old. This put the girls at risk of becoming
pregnant. Adolescent pregnancies cause adverse health, social and economic
implications for the parents, mothers and their children and usually for their
grandmothers as well.
Worldwide, many adolescents fall pregnant; at least 1 in 5 has one or more children or
is pregnant (Pathfinder International 2001:43). Each year about 1 million teenage girls
under the age of 19 become pregnant; out of whom 600,000 give birth, and 400,000
(40%) opt for abortion (Sadock & Sadock 2003:39).
According to the National Center for Chronic Diseases’ Prevention and Health
Promotion [NCCDPHP] (1999:57-61), the possible consequences of adolescence
pregnancy include:
•
Social impact through leaving school thus resulting in lack of education or skill for
a job and are unable to earn a living.
•
Sexually transmitted infections because HIV poses a danger to women with STIs.
•
Pregnancy and delivery pose a major health hazard for adolescents.
•
Anaemia due to malnutrition, resulting in inadequate iron reserves as their bodies
are still developing.
•
Obstructed labour due to cephalo-pelvic disproportion, especially in very young
adolescents (10-14 years old).
•
Abortion, which poses the greatest direct threat to the young women’s health.
6
In South Africa and Nigeria, Irinoye et al (2004:25), Williams and Mavundla (1999:62),
and Karim, Magnani, Morgan and Bond (2003:18-22) found that many adolescents were
sexually active and engaged in unsafe sexual practices. These activities result in STIs,
unwanted pregnancy, unsafe abortions and early childbearing, which always come with
additional health and social problems. The NCCDPH (1999:59) found that pregnancyrelated morbidity and mortality in developing countries was higher for women under 19
and those above 35 years of age.
In Tanzania, approximately 20% of women aged 15-19 years are mothers and another
5% are pregnant for the first time (NBS 2000:38). Physical problems experienced by
adolescent mothers younger than 20 years of age in Tanzania and Africa include
pregnancy-induced hypertension, premature labour and anaemia (NCCDPHP 1999:5960; RCHS 2003:6). These physical problems might remain undetected because they
attend antenatal clinics very late in their pregnancy. Many adolescents will need to
discontinue their education, limiting their chances of further education or training and
jobs, which can sustain these mothers and their children. Financial hardship can
aggravate the adolescent mother’s social adjustment problems, increasing the likelihood
of resorting to prostitution to augment their incomes. However, unmarried women are at
greater risk for the consequences of unintended pregnancy than their married peers
(NCCDPHP 1999:60).
1.2.3 Adolescent girls residing in Kinondoni Municipality
According to the 2002 Population and Housing Census, Kinondoni Municipality has a
total population of 1,083,913. Of the population, 56,710 are girls aged 10-14; 3,075 from
rural areas and 53,635 from urban areas; 72,376 are females between the ages of 1519, with 3,192 from rural areas and 69,184 from urban areas (NBS 2003:127).
Kinondoni Municipality has one government hospital and eleven private hospitals; two
government health centres, one parastatal and six private health centres; 24
government dispensaries, five voluntary agency dispensaries, five parastatal and 126
private dispensaries.
The Magomeni Reproductive and Child Health Clinic (MRCHC) is the largest
government health centre, in Kinondoni Municipality. According to clinic records from
7
January 2005 to September 2005, about 25 to 40 pregnant women attended the clinic
daily, with 3 to 6 among them being adolescents. Most of them made their first clinic
bookings during the second and even third trimester. Their attendance was reported to
be poor. In a study on obstetric outcomes among primigravida who delivered at the
Muhimbili National Hospital, Lyamuya (2002:22-26) found the majority of pregnant
women (adolescent and non-adolescent) came from Kinondoni Municipality and their
frequency of attending antenatal check-up was poor. Most of the adolescents booked
during the second trimester.
Furthermore, the adolescent mothers were at risk of
developing anaemia.
Table 1.3 indicates the pregnant adolescents, aged between 15 and19, who attended
the antenatal clinic at the Magomeni Health Centre, according to the clinic records for
January 2005 to September 2005.
Table 1.2
Pregnant adolescents attending antenatal clinic at Magomeni Health
Centre
MONTH
January
February
March
April
May
June
July
August
September
Gestational
Age <20 wks
61
38
27
31
36
29
23
45
22
Gestational
Age >20 wks
57
55
60
42
35
43
47
42
45
TOTAL
AVERAGE/DAY
118
93
87
73
71
72
70
87
67
6
5
4
4
4
4
4
4
3
Source: Magomeni Reproductive and Child Health Clinic 2005:19
All adolescents are referred to Muhimbili National Hospital for care and appropriate
management when they are at term, because all adolescents under 19 are considered
to be at risk (RCHS 2003:33).
8
1.3
PROBLEM STATEMENT
Burns and Grove (2005:70-71) define a research problem as “a situation in need of a
solution, improvement or alteration, a discrepancy between the way things are and the
way they ought to be”.
From the background to this study, it is evident that although reproductive healthcare
services and contraceptives are freely available in Tanzania (Kinondoni Municipality),
adolescent pregnancies nevertheless continue to increase. The research problem was
to identify the factors contributing to the high adolescent pregnancy rate in Kinondoni
Municipality, Dar-es-Salaam, Tanzania. Identifying the factors would facilitate making
recommendations to enable more adolescents to use the reproductive services
effectively and prevent unplanned pregnancies.
Through her nursing experience in the neonatal ward at Muhimbili National Hospital
(MNH) in 2004, the researcher was concerned of the number of teenage mothers aged
14 to19, who had their neonates there. According to the neonatal ward at MNH report,
from July 2002 to June 2003, the total number of neonates admitted was 7,988; with
1,809 (22.6%) premature and 1,504 (18.8%) birth asphyxia, and 1380 deaths. The main
causes of death were prematurity (507; 36.7%) and birth asphyxia (418; 30.72%), of
which most of the neonates belonged to adolescent mothers. In addition, a total of
13,241 deliveries were conducted at MNH (http://www.tanzaniagov.org.tz).
This concurs with Lyamuya’s (2002:33-34, 41) finding that the outcome of adolescent
mothers’ pregnancy was poor; most of the complications were birth asphyxia,
prematurity, and meconium aspiration, which resulted in increased foetal death.
This implied that women under 18 years are at high risk of pregnancy-related problems
and complications during pregnancy and delivery.
1.4
PURPOSE OF THE STUDY
The purpose of the study was to describe the factors that contribute to the high
adolescent pregnancy rate in Kinondoni Municipality to prevent unplanned pregnancies.
9
1.5
OBJECTIVES
Burns and Grove (2005:156) describe objectives as “clear, concise, declarative
statements expressed in the present tense and for clarity with only one or two
variables”. The objectives of the study were to
•
Determine the socio-economic characteristics of adolescents who become
pregnant.
•
Assess adolescent girls’ level of knowledge of reproductive health issues in
general.
•
Determine the source of their knowledge of reproductive heath issues.
•
Describe the factors contributing to the high adolescent birth rate.
1.6
RESEARCH DESIGN AND METHODOLOGY
1.6.1 Research design
A non-experimental exploratory, cross-sectional descriptive quantitative research design
was used to identify and describe the factors contributing to the high adolescent
pregnancy rate in Kinondoni Municipality, Dar-es-Salaam. The purpose of such a design
is “to provide an explicit description of the phenomenon explored so that it can be
addressed” (Burns & Grove 2005:34-35).
1.6.2 Setting
Tanzania has very good road and health services infrastructure for both urban and rural
areas. The health services are offered by government, parastatal, voluntary/religious,
private and non-governmental organisations. There are 6 consultancy/specialised
hospitals, 17 regional hospitals, 68 district hospitals, 96 other hospitals, 499 health
centres and 3,955 dispensaries. The services are spread throughout the country. The
health system, particularly the Government referral system, forms a pyramidal pattern of
referral from dispensary to consulting hospital (MOH 2002:51). Almost all the health
facilities provide reproductive health and contraceptive services.
The study was conducted in Kinondoni Municipality, Dar-es-Salaam, Tanzania.
10
1.6.3 Population and sampling
In this study, the target population consisted of all the adolescents girls between 10-19
years in Kinondoni Municipality.
1.6.4 Sampling
A multistage cluster sampling method was employed.
A list of all the wards in
Kinondoni Municipality was obtained and one ward was randomly selected. In the
second stage a list of sub-wards/streets in the selected ward was obtained, and two
sub-wards randomly selected. All the adolescents aged between 10 and 19 years, in the
selected sub-wards were included in the study.
1.6.5 Data collection
Data collection is a systematic way of gathering information, which is relevant to the
research purpose or questions (Burns & Grove 2005:421). Data was collected using a
structured questionnaire, specifically designed for this study, consisting of four sections.
A structured questionnaire “enables the investigator to be consistent in asking questions
and data yielded is easy to analyse” (Brink 2006:148). The questionnaires were
distributed to the adolescent girls and then collected after completion.
1.6.6 Data analysis
Data was analysed using the SPSS, Version 13.0, computer program with the
assistance of a statistician from Muhimbili University of Health and Allied Sciences.
Descriptive statistics as well as summaries, including frequency distributions and
percentages, were used.
1.6.7 Reliability and validity
According to Brink (2006:160), validity refers to “the degree to which the instrument
measures what it is supposed to measure”. The researcher focused on content validity,
which is the degree to which the items in an instrument adequately represent the
universe of the content. The researcher gave the questionnaire to adolescents from
11
Temeke Municipality to review/verify and validate the questions. The questionnaire was
also distributed to nurse tutors in the midwifery unit, as they are experts in the field of
mdwifery. These groups did not participate in the main study. The reviewers supported
the assertion that the components of the questionnaire accurately reflected the
phenomenon being studied and that the questions were appropriate to the factors
contributing to the high pregnancy rate in Kinondoni Municipality.
1.6.8 Pre-test (pilot study)
A pre-test, which is a smaller version of the study, was carried out to obtain information
to improve the questionnaire and to assess the feasibility of the study. The respondents
in the pre-test were similar to those in the study and it was done under similar settings.
Conducting a pre-test assisted the investigator to identify problems with the
questionnaire and indicated the time needed to complete the questionnaire, which was
important in obtaining consent to participate (Burns & Grove 2005:94).
1.7
ETHICAL CONSIDERATIONS
Pera and Van Tonder (2005:4) define ethics as “a code of behaviour that is considered
correct”. Ethical considerations in the conduct of research were followed to prevent
ethical dilemmas. To ensure ethical conduct of the study, permission to conduct this
study was obtained from the Kinondoni Municipal Medical Officer and the respondents.
Informed consent was obtained from each respondent. To ensure confidentiality and
anonymity, neither the name of respondents nor that of the institution involved was
requested on the questionnaires. No physical or psychological risks were involved as
the study was non experimental. The list of respondents’ names for sampling purposes
was kept safe to ensure confidentiality and anonymity (Brink 2003:47).
1.8
SIGNIFICANCE OF THE STUDY
This study aimed to identify and describe the factors that contribute to the high
adolescent pregnancy rate at Kinondoni Municipality. The researcher wished to identify
and describe the factors in order to reduce the number of adolescent pregnancies in the
area. Health education could then be modified according to the factors identified in
order to promote healthy lifestyles and informed decision-making among adolescents.
12
The effective implementation of recommendations based on the findings of the study
might also enhance the accessibility of reproductive and contraceptive health care
services to adolescents. Above all, adolescents could become empowered through
more appropriate health education, to make informed decisions not only about their
own, but also their children’s lives.
Identifying the factors, which prevent them from utilising the reproductive health
services, described by adolescents themselves would equip health care providers and
teachers to deal with those factors through health education at schools, social
gatherings, and media and health care centres. Moreover, recommendations could be
made to improve the productive health services, thereby enhancing their utilisation by
adolescents and assisting adolescents to make informed decisions about their own and
their children’s futures. Strategies could be developed and implemented in collaboration
with the government, NGOs, the private sector, key players and other collaborating
agencies and institutions supporting health and development work in Tanzania.
The strategies should focus on programmes that provide information to adolescents,
ensure access to reproductive health services, and develop life skills to empower
adolescents to continue with their education and attain higher education qualifications.
Such programmes might improve the health and future of young people in Tanzania to
become self-sustained adults, thereby alleviating poverty in the country.
In addition the findings of the study will contribute to the body of nursing knowledge,
especially in midwifery where midwives are actively involved in assisting individuals,
including adolescents, families and communities, to maintain, promote and restore
health during the events surrounding birth and throughout their life cycles (Nolte
1998:3).
As adolescent girls comprised the population of this study, the research results
pertained only to adolescent girls, not all adolescents. It is acknowledged that
adolescents who manage to avoid unplanned pregnancies might have knowledge,
attitudes and/or beliefs that differ from those of the respondents.
13
1.9
DEFINITION OF KEY TERMS
For the purpose of this study the following terms are used as defined below:
•
Adolescent
An adolescent is a young person who is developing from childhood into an adult:
adolescent between the ages of 13 and 18 (Oxford Advanced Learners’ Dictionary
2000:15). The WHO (1986:63) defines adolescence as an age range, the second
decade of life between 10-19 years.
•
Sexuality
Collins English Dictionary (1991:1418) defines sexuality as “the state or quality of being
sexual; preoccupation with or involvement in sexual matters; people’s sexual feelings;
the feeling and activities with a person‘s sexual desires: male/female sexuality”.
•
Pregnancy
Pregnancy is the condition of having a developing embryo or foetus in the body after
successful conception. The average duration of pregnancy is about 280 days.
Estimation of the date on which delivery should occur is based on the first day of the
last menstrual period (Taber‘s Cyclopedia Medical Dictionary 2001:1730). In this study,
it refers to pregnancies occurring during adolescence.
•
Reproductive health
The WHO (1986:81) defines reproductive health as “a state of physical, mental and
social well being in all matters relating to the reproductive system at all stages of life. It
implies that both men and women are able to have a satisfying and safe sex life and
that they have the capability to reproduce and the freedom to decide when and how
often to do so. Implicit in this are the rights of men and women to be informed and have
access to safe, effective, affordable, and acceptable methods of family planning of their
choice, and the right to appropriate health care services that enable women to safely go
through pregnancy and childbirth.”
Reproductive health in this study refers to the
14
provision of information, education and communication about reproductive health issues
to adolescents in order to reduce pregnancy.
•
Accessibility of health services
Accessibility implies that health services are capable of being used, easily approached
or easily approachable, and providing access to the people who wish to have those
health services.
•
Belief
A belief is something that represents personal confidence in the validity of some idea,
person or object. The cognitive component is based on faith rather than on fact. Belief
can either be true or false, correct or incorrect (Pera & Van Tonder 2005:80).
•
Conception
Conception is the union of male sperm and female ovum; fertilisation (Lodewig, London
& Olds 1998:811).
•
Contraception
This is the prevention of conception by using an agent such as a condom, spermicidal
pessary or cream, cervical diaphragm or intrauterine device, oral contraception or
natural methods (Brooker 2006:58).
•
Non-utilisation
This refers to when the reproductive health services are available but are not used, or
made use of, by those who need those services.
•
Sex education
Sex education is education on the subject of sexual activity and sexual relationships. It
includes teaching about the male and female body so that the learner can understand
15
expressing sexuality and recognise the onset of puberty; knowledge about personal
relationships,
knowledge
about
contraception,
sexually
transmitted
infections,
pregnancy, childbirth, bonding, parenting and family living (Brooker 2006:221).
•
Teenager
Collins English Dictionary (1991:1583) defines a teenager as “a person between the
ages of 13 and 19 inclusive”.
•
Termination of pregnancy (TOP)
This refers to the act of bringing a pregnancy to a final end, preventing the birth of a live
baby (Dickson-Tetteh 1999:20).
1.10
LIST OF ABBREVIATIONS
AIDS
Acquired Immune Deficiency Syndrome
ANC
Antenatal Clinic
G/A
Gestational age
HIV
Human Immune-deficiency Virus
IEC
Information, education and communication
MNH
Muhimbili National Hospital
MOH
Ministry of Health
NBS
National Bureau of Statistics
NCCDPHP
National Centre for Chronic Diseases and Promotion of Health
NGO
Non-Government Organisation
NHP
National Health Policy
PMCT
Prevention of Mother-to-Child Transmission
REL
Religious
RCHS
Reproductive and Child Health Section
SRH
Sexual and Reproductive Health
STIs
Sexually Transmitted Infections
WHO
World Health Organization
VCT
Voluntary Counselling and Testing
VOL
Voluntary
16
1.11
OUTLINE OF THE STUDY
Chapter 1 discusses the background to the study; the research problem; the purpose,
objectives and significance of the study; the research design and methodology, and
ethical considerations, defines key terms used, and briefly outlines the study.
Chapter 2 discusses the literature review on factors contributing to high adolescent
pregnancy rates.
Chapter 3 describes the research design and methodology, including the population and
sample, data collection and the data-collection instrument.
Chapter 4 deals with the data analysis and interpretation.
Chapter 5 presents the findings and makes recommendations to improve the factors
contributing to high adolescent pregnancy rate in Kinondoni Municipality and for future
research.
1.12
CONCLUSION
This chapter briefly discussed the study, background to the problem, the problem
statement, the purpose and significance of the study, the research design and
methodology, including population and sample, data collection, reliability and validity
and ethical considerations, and defined key terms.
Chapter 2 discusses the literature review undertaken for the study.
17
Chapter 2
Literature review
2.1
INTRODUCTION
This chapter deals with the literature review on the problem of adolescent pregnancy
and factors that contribute to it.
2.2
REASON FOR A LITERATURE REVIEW
The purpose of a literature review is to familiarise the reader with practical or theoretical
issues relating to the problem and helps the researcher to lay a foundation for the study.
A literature review indicates what is known about an area of inquiry and suggests ways
of conducting the study on the topic of interest (Polit & Beck 2004:88).
The literature review on factors contributing to adolescent pregnancy assisted the
researcher to formulate appropriate research objectives and gain further insight into the
problem and the factors contributing to the high adolescent pregnancy rate.
The review of literature revealed the following significant issues related to the research
topic “high adolescent pregnancy rate”.
2.3
ADOLESCENCE
2.3.1 Definition
Adolescence is “the period between the onset of puberty and full maturity; youth”
(Brooker 2006:5). It is characterised by profound biological, psychological, and social
developmental changes (Sadock & Sadock 2003:35).
18
2.3.2 Adolescent identity
During adolescence, the young person’s major task is to achieve a sense of selfidentity. This adolescence crisis is partly a result of the move from dependency to
independence: it is mainly on sex roles and gender identification. Failure to achieve this
develops identity diffusion in the adolescent, which is a failure to develop a cohesive
self-awareness.
During this period adolescents are negative and in turmoil in the
process of becoming independent. Adolescents’ world is outside at school and in
relationships with persons of similar ages and interests; they see themselves through
the eyes of their peers. Parents/guardians need to be watchful of any changes of
behaviour (Heaven 2001:29; Sadock & Sadock 2003:37).
2.3.3 Developmental stages of the adolescent
All human beings pass through the stages of adolescence.
2.3.3.1 Piaget’s stages of cognitive development
Cognitive development begins when the achievements of late childhood are integrated
into the person and ends when that person is eager to assume the adult role and can do
it capably. Cognitive development is influenced by society and culture, including family,
peers, school, church, and adolescents’ heroes. Children progress from the concrete to
the formal operational stage (11-15 years); they are able to solve problems that involve
scientific and verbal reasoning.
They are able to make use of assumptions while
thinking, formulating hypotheses and constructing theories, and are future oriented
(Heaven 2001:19; Marlow & Redding 2001:1129).
2.3.3.2 Erickson’s psychosocial stages of development
Erickson identifies eight psychosocial stages of development, at each of which there is
a developmental (potential) crisis or turning point. During adolescence the potential
crisis is identity versus identity confusion.
When the adolescent is successful, it
facilitates positive emotional and social adjustment for the next stage (Heaven 2001:25;
Marlow & Redding 2001:1124).
19
2.3.4 Physiological and psychosocial development of the adolescent girl
Adolescence occurs when the secondary sex characteristics appear and ends when
somatic growth is completed and the individual is psychologically and physiologically
mature and capable of contributing to society. The pubescent period for girls begins
when growth spurts occur. During this stage, growth is rapid. Their skeletal system
often grows faster than their support muscles, which tends to cause clumsiness and
poor posture. At this stage, girls increase in height and weight.
The increase in
testosterone and androgen results in the production of secondary sex characteristics.
Changes in girls appear in this order: an increase in transverse diameter of the pelvis,
development of breasts, changes in the vaginal secretions, pubic and anxillae hair
growth. First menstruation (menarche) occurs between the appearance of pubic hair
and that of axillae. After pubescence, growth is gradual and girls are capable of
reproduction. Usually there are heightened sexual tensions: girls are ready for
heterosexual genital expression, which they are denied, become confused and full of
anxiety (Dlamini & Van der Merwe 2002:52; Marlow & Redding 2001:1120, 1128).
Psychosocial development refers to teenagers’ growing ability to relate realistically to
other people, to learn to become a mature partner in an intimate relationship, and to see
themselves realistically. It starts during adolescence and continues to early adulthood.
In order to be psychosocially developed one has to separate effectively from parents to
adulthood while interacting, to choose a vacation, to mature sexually and develop a
realistic and positive self-image. This is the period when they need much support,
guidance, firm limits and unconditional love from the parents and community to develop
to their full potential (Heaven 2001:27-33).
2.4
FACTORS CONTRIBUTING TO ADOLESCENT PREGNANCY
The incidence of adolescent pregnancy is increasing and has become a worldwide
concern. Among the developed countries, the United States of America (USA) has
approximately 850,000 teenagers who become pregnant each year. Although they are
making much progress in lowering those rates by developing relevant strategies, they
still have a long way to go (Realini 2004:33).
20
In 2000, the UK had the highest rate of teenage pregnancies. About 38,690 girls under
the age of 18 became pregnant and 44.8% of those pregnancies resulted in legal
abortions; 7,617 of those conceptions were under 16 years, and 54.5% of conceptions
ended in legal abortions. This generally endangers the life of the adolescent girl and
necessitates developing strategies to reduce the high incidence rate (Linda 2003:1)
In many African countries more than 20% of women aged 15 to 19 have given birth to at
least one child. In Nigeria, Mauritania and Sudan, more than 15% of the girls have given
birth before age 15 (NCCDPH 1999:51). According to Irinoye et al (2004:1), about 43%
of pregnancies among Nigerian adolescents occurred in non-marital relationships.
Factors that contribute to a high adolescent pregnancy rate include early menarche,
adolescent sexual behaviour, socio-cultural and economic factors, educational status,
sexual violence, peer pressure, and urbanisation.
2.4.1 Early menarche
The earlier the occurrence of menarche, the earlier the biological possibility of
conceiving.
In Dar-es-Salaam, Tanzania, Nasoro (2003:25) found that the age of
menarche was between13 and 15 years, and was associated with increased sexual
activity, which put teenagers at risk of unwanted pregnancies and STIs.
In the Southern Hho-Hho region of Swaziland, Dlamini, Van der Merwe and Ehlers
(2003:78) found that the average age of menarche was 11 years, and their first sexual
intercourse was reported to happen between the ages of 11 and 14. Due to lack of
knowledge, advice and emotional support, the youngsters practised unsafe sex and
were not aware that they could be pregnant or contract HIV/AIDS.
2.4.2 Adolescent sexual behaviour
There is a great surge of genital sexual development during adolescence. Due to the
increased hormones, secondary sexual characteristics appear. Masturbation and sexual
fantasies are common. In general, adolescents face a confusing and difficult time and
need parental guidance (Heaven 2001; Marlow & Redding 2001:1127-1129).
21
Moore, Miller, Sugland, Morrison, Glei and Blumenthal (2004:1-9) found that early
sexual activity is affected by developmental characteristics, such as early puberty and
high levels of androgen hormones (i.e. testosterone), which are associated with
increased adolescent sexual behaviour.
2.4.3 Socio-cultural and economic factors
Early dating provides a context for many sexual experiences. Unconventional
psychosocial attitudes and some risk behaviour, such as early use of alcohol, tobacco
and drugs; school problems; delinquency, and physical aggression are associated with
earlier onset of adolescent sexual intercourse. Other factors include lower family
incomes, less supervision, parental modelling, and more permissive attitudes in singleparent families. Having sexually active siblings and friends is also strongly associated
with earlier onset of sexual activity at a young age (Blum 2000:5; Ikamba & Quedraogo
2003:7).
Regarding socio-economic and cultural factors associated with pregnancy among
adolescent girls, Muchuruza (2000:35) found that adolescents were at high risk of
pregnancy at the ages of 14 to 16 years. Moreover, the risk was fifteen times higher in
respondents with no formal education and no employment. Also, girls were affected by
the mothers’ education and the living patterns in the home; living with one parent only or
with a guardian compared to living with both parents, and finally, girls from families of
low socio-economic status had a higher risk of pregnancy. In Taiwan, Wang, Wang and
Hsu (2003:33-44) found a lack of necessary material resources to meet the needs of
adolescents, because of parents’ poor socio-economic status, put adolescent girls at
greater risk of pregnancy.
According to Ellis, Bates, Dodge, Ferguson, Horwood, Pettit and Woodward (2003:801821), the fathers’ absence had a greater impact on their daughters’ sexual activity and
teenage pregnancy than on other behavioural or mental health problems or academic
achievement. This shows the importance of fathers’ involvement and responsibility in
raising their children. In Logan, USA, Miller (2002:22-26) revealed similar results in a
study on family influences on adolescent sexual and contraceptive behaviour.
22
The cultural practices of socialising adolescents into adulthood range from taboos
against premarital sexual encounters to encouragement of child indulgence in
premarital sex. For example, in a qualitative study in Nigeria, Irinoye et al (2004:27)
found that some mothers at times encouraged their sons in sexual activity, as they
wanted them to be “real men”, and asked their sons if something was wrong if there
were no signs of relationship with girls.
2.4.4 Educational status
Women with more education are more likely to delay child bearing. In some countries in
Sub-Saharan African, more women with less than seven years’ education have a child
before they are 18 than ones with seven or more years of education. In the USA,
approximately 30% of young women who have less than a basic education (at least
seven years) have a child before they are 18 compared to 5% of those who have at
least twelve years of education (Ventura, Abma, Mosher & Henshaw 2004:1-9).
The risk of pregnancy is greater among adolescents with no formal education than with
those with secondary education (Muchuruza 2000:48). Moreover, a lack of parental
guidance and appropriate sex education contributes to teenage pregnancy (Wang,
Wang & Hsul 2003:33-44).
2.4.5 Sexual violence
According to Gray, Wagman, Nalugoda, Lutalo, Zablotskal and Koenig (2004:156-163),
among rural adolescents aged 15 to 19 in Uganda, both unwanted and mistimed
pregnancies were more common among those who had been coerced than those who
had not. Coerced sexual intercourse represents only one of the more extremes of
sexual abuse.
In Dar-es-Salaam, many victims of rape are between 12 and 17 at the time of the rape,
and pregnancy is one of the outcomes (Muganyizi 2001:42-49). This has adverse
consequences for young women’s future sexual and reproductive health.
In the USA, Moore et al (2004:4-8) report a significant increase in sexual activity among
females aged 14, 15 and 16 compared with young women of the same age 15 years
23
ago. Furthermore, the younger the age of first sexual intercourse, the more likely that
the experience was coercive and forced; the greater the risk of unwanted pregnancy
and STIs, and less likely the use of contraceptives and generally these youngsters have
more sexual partners.
Regarding the prevalence of sexual abuse in childhood (age below 15), Garcia-Moreno,
Jansen, Elsberg, Heise and Watts (2005:49-54) reveal that many victims have their first
sexual experience as a product of coercion or force. This is of grave concern as the
outcomes of sexual abuse include unwanted pregnancy and STIs, including HIV/AIDS.
The abuse is a severe violation of girls’ basic rights and bodily integrity.
Coercive sex and rape, poor contraceptive knowledge and poor contraceptive selfefficacy are major factors in teenage pregnancy (Wang et al 2003:33-44; Rwengwe
2000:118-123; Buga, Amoko & Ncyiyana 1996:95-100; Nasoro 2003:23-25; 28).
2.4.6 Peer pressure
In a study on high-risk sexual behaviour in Tanzania, Ikamba and Quedraogo (2003:112) found that youth are forced into having sexual intercourse by peer pressure. Peer
pressure plays a role in initiating sexual activity, which frequently ends in adolescent
pregnancies. Poverty for girls (especially with poor parents) is another factor. Initiation
rituals for girls encourage sexual activity, as some of the girls immediately practise what
they have been taught, and no appropriate information is given of how to prevent
disease and unwanted pregnancy.
Having frequent sex; forced sex initiation; not owning a television set; a larger
household and poor house; not living with their biological father; not talking openly
about sex with a boyfriend, and also perceiving most friends to be pregnant are other
risks for teenage pregnancy (Vundule, Maforah, Jewkes & Jordan 2001:73-80).
In a qualitative study on the context of adolescent pregnancies in Medellin, Colombia,
Cuesta (2001:180-192) found that adolescent pregnancy occurs in the context of a
“genuine love affair” in which ideas of romantic love and gender rules are powerful
influences on those who unintentionally become pregnant. However, the results might
be specific to that group and the opinion of boyfriends could have enriched the analysis.
24
2.4.7 Urbanisation
In Tanzania, factors that have influenced the adolescents’ life style include
modernisation accompanied by industrialisation; access to mass media; rural-urban
migration; influx of refugees, and the introduction of a free market economy. All these
factors have changed the traditional system of socialising the young people to
adulthood.
2.5
REPRODUCTIVE HEALTH SERVICES TO ADOLESCENTS
2.5.1 Types of reproductive health services
In Tanzania, the Ministry of Health has made provision for a range of reproductive
health services to be provided in public, private and NGO settings and outlets. The
services include
•
Information and counseling on reproductive health, sexuality and safe sex
•
Testing services, VCT, STI and Pregnancy
•
Management of STI, VCT+, PMTC+, HIV/AIDS
•
Focused antenatal care
•
Care during childbirth
•
Postnatal care
•
Post-abortion care
•
Contraception, including emergency contraception
•
Condom promotion and provision
•
Other related health issues: substance abuse, violence, injuries and mental
health
•
Referrals to specialist health care centres
Nevertheless, sexual and reproductive services for adolescents are still surrounded by
stigma, especially among parents, community leaders, religious leaders, service
providers and even programmes for adolescent care. Consequently, adolescents are
still denied access to reproductive health services. Existing services are not adolescent
friendly in terms of type and quality of services offered, time of service, location and
affordability. Expertise is lacking in schools. In short, adolescents have not benefited in
25
spite of favourable policies and guidelines (RCHS 2004a:12). At the same time, if these
services could benefit adolescent girls, then they could complete school, get jobs and
thus raise their own, their family’s and the country’s economic status (RCHS
2004b:113).
2.5.2 Contraception
One of the most important reproductive health services for the adolescent is
contraceptive services. Contraception for adolescents is a big problem because, in
order to use contraceptives, prior planning is needed. In the researcher’s experience,
adolescents report that their first sexual intercourse usually “just happened” and that
they did not plan to have sex at the time.
It is generally believed that condom use requires the least advance planning and is
used more than any other method of contraception. However, about 35% use no
method on their first sexual intercourse. Usually sexual activity is sporadic rather than
deliberate and rational.
Contraceptive use in Tanzania is low, especially among adolescents aged 15 to 19
(6%). The low contraceptive use among women may reflect lower levels of sexual
activity or a desire to start a family. The most popular contraceptive method is a condom
(NBS 2000:46, RCHS 2004a:4)
In Dar-es-Salaam, Nasoro (2003:25) found that contraceptive awareness was good
among adolescents as some knew or mentioned at least one type of contraceptive.
However, some admitted not using any form of contraception. Some of the girls did not
use any method because they claimed to have had sexual intercourse once or twice
and not become pregnant, so thought it would not happen to them. N’gwalida (2001:29),
however, found lack of knowledge of methods of contraception given by teenagers aged
15 to 19 as the reason for not using contraceptives.
An investigation into factors affecting condom use among 446 junior secondary school
pupils in South Africa revealed that about one year after puberty 149 pupils (70 females
and 79 males) had engaged in sexual activity (Peltzer 2000:37-44). Of these, most
knew about condoms prior to first sex; only 25.3% of the boys and 71% of the girls used
26
condoms the first time, and most of the boys and almost one third of the girls reported
never using condoms. Regarding adolescents’ knowledge, beliefs and experiences of
sexual practices, Khoza (2004:39) reported that the girls emphasised that having sex
without a condom was the worst criminal offence, because boys flitted around spreading
HIV and STIs. This, then, indicated that these girls were aware of risky sex practices.
Maja, Ehlers and King (2004:30-34) found that both adult and adolescent women lacked
knowledge about emergency contraception, which could prevent unwanted pregnancies
in the event of unprotected sexual intercourse. The adolescents were negative about its
use.
In a study of sexual behaviour among 2 740 high school students in Cape Town, South
Africa, Carl, Muller, Reddy and Flisher (2003:537-540) found that 29% had participated
in sexual intercourse. By the age of 14, 23.4% males and 5.5% females had
participated in sexual intercourse; by 19, the proportions were 71.8% and 58.2%,
respectively. It also revealed that at their last coital episode, 65.4% had used
contraception and the most common methods were condoms (67.7%) and injectable
steroids (43.2%).
According to Williams and Mavundla (1999:62), among 42 teenage mothers only 2.4%
used condoms. Although they acknowledged the use of condoms to be the safest
method, they did not use condoms. The girls supported the use of condoms, but their
boyfriends refused and the girls yielded to the pressure in spite of the ill effect.
Heaven (2001:132-133) maintains that the practice of contraception among sexually
active adolescents is linked to cognitive development. Adolescents’ formal reasoning
does not comprehend the different forms of contraception, nor do they evaluate the
consequences of their actions, and males do not consider the risks of pregnancy to their
female partners.
2.5.3 Life skills education
The life style of the adolescent is greatly influenced by the family, peer, teachers, and
religion and traditions. At home, parents and other adults are role models. At the same
time, the peer group greatly influence adolescent girls. During adolescence they are
27
expected to be knowledgeable in order to postpone intercourse or, if they do have sex,
to use condoms. Young people need education on human development, reproductive
health, anatomy and physiology; relationships with family friends as well as dating;
sexual behaviour such as abstinence as well as sexuality throughout the life cycle;
sexual health, including contraception, STI, HIV/AIDS, prevention of sexual abuse, and
abortion; their society and culture such as gender roles and religion. In addition they
need personal (life) skills such as values, decision-making, communication and
negotiation. They need to understand risk behaviour and the consequences, and where
they can go for reproductive health services (Blum 2000:3; Buga et al 1996:95-100;
Ehlers 2003:19-21).
2.6
SUPPORTIVE ENVIRONMENT TO THE ADOLESCENT GIRL
Adolescents need support to develop into mature adults. Parents are the main support
structure, as well as the community, religion, schools and cultural aspects.
2.6.1 Parents
Blum (2000:1-5) emphasises that “the strong message to parents is that you need to be
in your kid’s life: know their friends, what their friends do, and who their friends’ parents
are. The messages for all adults is to set clear expectations regarding school
performance, skipping school or doing poorly is not just an educational threat, it’s a
health threat. We need to provide resources to help capture the interest of kids who are
disenfranchised.”
Nasoro (2003:30) maintains that parents should be educated on the importance of
striving for the education of their female children and postpone their marriage until they
are 20 years and older. It is very important to involve adolescent boys and men in the
fight against adolescent pregnancy and its consequences.
According to Marlow and Redding (2001:1122), many parents do not adequately explain
to their girls the various changes in the body that indicate puberty. Girls should have a
clear understanding of ovulation, fertilisation, pregnancy and childbirth before the onset
of menstruation. This will minimise their anxiety and empower them to face the future.
28
Parents should take responsibility for guiding the youth to avoid engaging in sexual
activities at an early age. This is to avoid the risk of contracting STDs & HIV/AIDS and
unwanted pregnancies (Ikamba & Quedraogo 2003:12).
Parents should play a significant role as sexuality educators for their children. Many
parents are not ready to discuss with their children, they assume that their get
information from school (Khoza 2004:39; Miller 2002:22-26).
According to Moore et al (2004:1-8), having better educated parents, supportive family
relationships, parental supervision, sexually abstinent friends, good grades and
attending church frequently are all related to later onset of sexual intercourse.
2.6.2 Community/religion
Information, communication and education should be provided to the existing groups in
the community, in relation to changes which take place in adolescent girls’ bodies and
the consequences of early sexuality, namely teenage pregnancy and sexually
transmitted infections including HIV/AIDS, and ill effect of abortion (Ikamba &
Quedraogo 2003:1-12). If women and church/religious groups are empowered, they can
play a big role in educating adolescent girls.
Marlow and Redding (2001:1129) assert that spiritually adolescents are in the stage of
synthetic-conventional faith. An adolescent without religious ties is likely to be attracted
to any new or different religious cult and undesired behaviour. Parents need to be
aware of this and help adolescents explore their feelings and concepts.
2.6.3 School
In Tanzania, sexual and reproductive health is taught in schools, but it is inadequate in
content and methods, particularly due to scarcity of information, education and
communication (IEC) materials.
Schools are also not equipped.
Teachers receive
insufficient training in reproductive health issues. In spite of developing national policy
guidelines for reproductive health services, many young people have not benefited from
them, due to low coverage of targeted audience, and other critical constraints such as
limited resources and cultural barriers (RHCS 2004b:10).
29
In Mwanza, Tanzania, in most cases (94%; 96/120) became pregnant while they were
out of school (completed primary school or dropouts) compared to 20% who became
pregnant while in school, which means attending school could be a deterrent for
becoming pregnant (Muchuruza 2000:27-53).
2.6.4 Cultural support
Maluleke (2003:64-65) found that during initiation, sexuality education was limited to
personal hygiene, maintaining virginity, self-control and social morals. Abstinence was
mentioned as a way of preventing HIV/AIDS, but nothing was said about HIV and its
prevention, and it was done in a calm environment. However, the girls indicated that
the information was inadequate and unclear.
Initiation rituals for girls that encourage sexual activity should be looked into so that they
become beneficial to the girl (Ikamba & Quedraogo 2003:12).
In general, parents and communities are not adequately equipped to prepare their
children for adult life. In addition, low literacy among the traditional/community leaders
means that they are increasingly cut off from information on new and emerging sexual
and reproductive health issues.
2.6.5 Health providers and governments
It is important for health providers to assist parents to value sexuality education for their
children, display moral values, and delay sexual activity and encourage the use of
condoms and contraception for those who are sexually active. These may reduce the
frequency of intercourse, promote safer sexual behaviour, and reduce unwanted
pregnancies as well as HIV/AIDS and STIs (Miller 2002:22-26). Williams and Mavundla
(1999:62) found that health workers were not able to help adolescents during this era of
primary health care orientation, as it addresses the basic local needs and problems.
Health providers should be knowledgeable and involved in addressing issues related to
adolescents’ problems. Ikamba and Quedraogo (2003:1-12) stress that governments
should continue developing strategies to assist adolescents by having clinics with
services that are accessible, affordable and friendly, where they can be counselled
about reproductive issues and hence meet their needs.
30
In support of adolescents, the MOH of Tanzania has developed a National Health and
Development Stakeholders Board to guide sexual and health intervention. The main
aim is for the health services to be accessible, appropriate, affordable, and adequate
and of acceptable quality.
In addition, adolescents who become pregnant, will be
provided with appropriate reproductive healthcare for optimal health development, and
those with reproductive problems would be referred to higher levels of care for
appropriate management (RCHS 2003:31-33)
In the US, the government is committed to continuing efforts to prevent out-of-wedlock
teen pregnancies, STIs, including HIV/AIDS, infection. Adolescents are encouraged to
abstain from sexual activity until marriage (Department of Health and Human Services
2002:72).
2.6.6 Adolescent involvement and peer influence
Effective interventions require adolescents’ active involvement in the definition of the
problems and their solution. Among the strategies to reduce teen pregnancy is an
approach that involves education, health, social services, media, parents and, most
importantly, the young people themselves (Linda 2003:7).
While young people’s involvement in sexual activity is fairly high, their awareness and
knowledge regarding physiological, psychological and physical changes associated with
adolescents is relatively low. Teenagers are optimistic and approve the inclusion of sex
education in the school curriculum (Williams & Mavundla 1999:62).
Pardue (2003:1) found that ”increased abstinence was the major cause of declining
birth and pregnancy rates among single teenage girls“.
Williams and Mavundla (1999:62) maintain that teenagers should wait for maturity
before engaging in sexual intercourse to enable them to develop emotionally,
intellectually and physically.
Dlamini et al (2003:80-82) found that parents, partners, peer groups, health personnel,
teachers, church leaders and communities fail to empower adolescent mothers with
31
knowledge and skills to prevent pregnancy or to face motherhood.
As a result
adolescents suffered socially, culturally and spiritually.
2.7
EDUCATION AND COMMUNICATION
2.7.1 Education is power
Adolescent girls should be educated because education can reduce fertility by (Khoza
2004:39; Little 1997:45):
•
Removing girls from domestic environment where early marriage and
childbearing is encouraged.
•
Allowing women to gain skills and education that may give them greater
independence and social freedom.
•
Encouraging women to achieve their educational ambitions and marry later.
2.7.2 Knowledge of adolescents’ on reproductive health issues
Adolescents need to have knowledge about sexual and reproductive health issues,
including preventive, promotive, rehabilitative and curative services that are appropriate
to their needs.
Many adolescents do not feel that they are at risk of contracting HIV/AIDS when they
practise sex without using condoms. Sometimes boys are ready to use condoms, but
the girls are not because they have poor knowledge of the use of condoms or because
of rumours on condom use. For example, rumours that condoms “may remain in the
womb during sexual intercourse” or “carry viruses” and if girls carry condoms with them
“they are thought to be prostitutes”. This shows lack of information, and education about
condoms, which puts them at risk (Peltzer 2000:37-44; Ikamba & Quedraogo 2003:8).
Peltzer (2000:40) found that the majority the secondary school respondents indicated
that their source of condom information (in order of importance) was radio, television,
educational talks, newspaper, social/health magazine, posters and pamphlets, and
health care providers. They also admitted having been given free condoms. In South
Africa condoms are freely available. Correct condom knowledge was associated with
32
the source of information: social/religious organisation, health care providers and
posters and pamphlets.
In Limpopo Province, South Africa Khoza (2004:34-41), found that the adolescent
participants regarded unprotected sexual intercourse, teenage pregnancy, abortion,
rape, prostitution, contraceptives, starting sex at an early age, homosexuality, and
having many sexual partners as risky sex practice. In particular, rape was associated
with failure in relationships and the fact that girls wore mini-skirts.
Sexuality education has been found to be successful in promoting abstinence,
decreasing sexuality activity, increasing use of safer practices, increasing teenage sex
responsibility, and increasing sex-related knowledge. Furthermore, sexual education
aids youth towards more responsible sexual decision making, delaying the age at which
first sexual intercourse occurs, and not encouraging earlier sexual activity or multiple
sexual partners (Khoza 2004:40-41)
2.8
EFFECTS OF PREGNANCY ON THE ADOLESCENT GIRL
Early childbearing affects the girl socio-economically, educational opportunities and
restricts skills for young people needed to succeed in work and life, reduces quality of
their lives and exposes them to STIs. The community also regards them as outcasts.
2.8.1 Interruption of schooling
Out of girls who leave school because of pregnancy, very few return to school after
delivery. Having lost a year of schooling, their performance at school deteriorates due
to the added responsibility of caring for the baby. Some drop out of school altogether.
These dropouts have less chance of being employed and suffer financially, thus
continuing to be dependent on their families and becoming a burden to them (Mmari,
Mchumvu, Silberschmidt & Rasch 2000:52-59; Dlamini and Van der Merwe 2002:5155).
33
2.8.2 Gender education
In Tanzania, in 2005 the net enrolment ratio (NER) at primary education was 94.8%.
The ratio for boys was 95.6% and for girls 93.8, but this ratio dropped drastically to
10.3% in the same year for secondary education. This is an indication that very few of
the pupils who finish primary education access secondary education. It also means that
only about 1 out of 10 Tanzania children of secondary school-going age (14-17) is
actually in school. The remaining 9, which may include as many as 5 girls, are not
attending school and therefore vulnerable to sex activity and candidates for unwanted
pregnancy.
Irinoye et al (2004:29) found that adolescents’ main concerns are disruption in
academic work and the negative consequence thereof for future career prospects. In
addition expulsion from school, ill health due to poor economic status, being treated as
an outcast in the community and having an “illegitimate child” were all the concerns of
adolescent mothers.
2.8.3 Sexually transmitted diseases
According to the RCHS (2004a:4) and NCCDPHP (1999:57-61), aside from pregnancy,
STIs, including HIV/AIDS, are the greatest risk of sexual activity, which poses a serious
health problem among adolescents. The distribution of STIs by age group and sex in
Tanzania revealed that three times as many boys as girls under 15 years had
contracted a curable STI; twice as many female adolescents (aged 15-19) were
reported with STIs, and young women aged 15-19 are four times more likely to contract
HIV/AIDS than their male counterparts.
2.8.4 Abortion
Abortion poses the greatest direct threat to a young woman’s health. Abortion is illegal
in many African countries and account for about one-fifth of all maternal deaths in East
Africa. The abortion rate in Tanzania remains largely unknown. Available hospital-based
data suggest that young women are more likely to undergo unsafe abortion than older
women, possibly because of limited access to reproductive health services.
34
More
adolescents suffer from abortion-related morbidity and mortality than those in the childbearing age of 18-35 (NCCDPHP 1999:57-61; RCHS 2004a:3).
2.8.5 Complications during pregnancy and delivery
The risk of death in childbirth is twice as high for a mother aged between 15 and 18
than for a mother aged 20 or over. Pregnancy-related morbidity and mortality in
developing countries is higher for women under 19 and above 35 years of age. The
complications include anaemia, toxaemia, premature delivery, prolonged/obstructed
labour, vesico-vagina fistula and cervical trauma, and a higher risk of delivering lowbirth weight babies. The infant mortality rate for infants born of an adolescent is higher.
In general, children of teenagers are 1.2 times more likely to die during the neonatal
period, 1.4 times more during the postnatal period, 1.6 times during ages 1 to 2 and 3.3
times during childhood to age 5 (NBS 2000:11; NCCDPHP 1999:59; Ojo et al 2004:37).
The implication of these effects is that women under 18 are liable to some pregnancyrelated problems and complications during pregnancy and delivery.
2.8.6 Other factors
The literature review did not emphasise religion or national campaigns as factors in
reducing adolescent pregnancies.
The researcher found only passing reference to
deliberate efforts by national leaders in the USA against adolescent pregnancy.
2.9
CONCLUSION
This chapter discussed factors that contribute to adolescent pregnancy, effects of
pregnancy, sexuality and reproductive issues, community support, and information
education and communication. Adolescent pregnancy is a major sexual and
reproductive concern in Tanzania, Africa and elsewhere. Adolescent mothers are likely
to suffer from severe complications during pregnancy and delivery that result in higher
morbidity and mortality for both mother and child.
Chapter 3 describes the research design and methodology.
35
Chapter 3
Research design and methodology
3.1
INTRODUCTION
This chapter discusses the research design and methodology, including the population,
sampling, and data collection and analysis.
3.2
PURPOSE OF THE STUDY
The purpose of the study was to describe the factors that contribute to high adolescent
pregnancy rate in Kinondoni Municipality to prevent unplanned pregnancies.
The objectives of the study were to
•
determine the socio-economic characteristics of adolescents who become
pregnant
•
assess adolescent girls’ level of knowledge of reproductive health issues in
general
•
determine the source of their knowledge of reproductive heath issues
•
describe the factors contributing to the high adolescent birth rate
3.3
RESEARCH SETTING
The research setting is “the environment in which the research study takes place and
can be a natural or controlled environment. Natural settings are real-life study
environments without any changes made for the purpose of the study” (Burns & Grove
2005:325).
The study was conducted in the two sub-wards of Midizini and Mnazimmoja, in
Manzese Ward, division of Magomeni in Kinondoni Municipality, Dar-es-Salaam,
Tanzania. The study was conducted in a natural setting, as there was no manipulation
36
of the environment; no changes were made to the community area, and no special
treatment given to the respondents, which could have affected the results.
The data was collected during normal working hours, Monday to Friday. Therefore the
respondents remained in the natural surroundings common to them, which are used for
community gatherings like community meetings, health meetings as well as political
meetings. The doors were closed during data collection with the respondents to provide
privacy. According to the Kinondoni Municipality records, between the communities,
there is an estimated catchment area population of 66,866 people in Manzese ward, of
whom at least 32,477 are females (http://www.Kinondonimunicipality.go.tz/).
3.4
RESEARCH DESIGN
Polit and Beck (2004:49) describe the research design as “a blueprint, or outline, for
conducting the study in such a way that maximum control will be exercised over factors
that could interfere with the validity of the research results. The research design is the
researcher’s overall plan for obtaining answers to the research questions guiding the
study.” Burns and Grove (2005:211) state that designing a study helps researchers “to
plan and implement the study in a way that will help them obtain the intended results,
thus increasing the chances of obtaining information that could be associated with the
real situation”.
The researcher chose a quantitative cross-sectional descriptive and exploratory
research design to describe the factors contributing to the high adolescent pregnancy
rate in Kinondoni Municipality, Dar-es-Salaam.
3.4.1 Quantitative research
This study attempted to quantify factors identified as contributing to the high pregnancy
rate of adolescents in Kinondoni Municipality, Dar-es-Salaam. Quantitative data can be
transposed into numbers, in a formal, objective, systematic process to obtain
information and describe variables and their relationships (Brink 2006:91).
Quantitative research has the following characteristics (Burns & Grove 2005:24-25;
Brink 2006:10-11):
37
•
There is a single reality that can be defined by careful measurement.
•
It is usually concise.
•
It describes and examines relationships, and determines causality among
variables, where possible.
•
Statistical analysis is conducted to reduce and organise data, determine
significant relationships and identify differences and/or similarities within and
between different categories of data.
•
The sample should be representative of a large population.
•
Reliability and validity of the instruments are crucial.
•
Comprehensive
data
collected
by
employing
different
methods
and/or
instruments should result in a complete description of the variable or the
population studied.
•
It provides an accurate account of characteristics of particular individuals,
situations, or groups.
3.4.2 Exploratory descriptive design
The study was exploratory because it explored the factors contributing to the high
adolescent pregnancy rate in Kinondoni Municipality. Exploratory research studies what
has previously been studied and attempts to identify new knowledge, new insights, new
understandings, and new meanings and to explore factors related to the topic (Brink
2006:102) The design was exploratory because it attempted to investigate the full
nature of the phenomenon (high pregnancy rate among adolescents in the Kindononi
municipal Municipality), the manner in which it becomes manifested as well as related
factors that could influence the adolescent pregnancy rate (Polit & Beck 2004:19-20).
Results of exploratory studies cannot necessarily be generalised to a larger population
but provide a better understanding of the sample being examined (Burns & Grove
2005:356-357). Exploratory research examines the relevant factors in detail to arrive at
an appropriate description of the reality of the existing situation (Brink 2006:104). The
researcher deemed this approach suitable for gaining a better understanding of the high
pregnancy rate in the Kinondoni Municipality.
38
3.4.3 Descriptive
The study was descriptive in that the researcher collected detailed descriptions of the
factors that contributed to the high pregnancy rate from pregnant and non-pregnant
adolescents. The factors identified were described accurately. Burns and Grove
(2005:44) define the purpose of descriptive research as “to provide the opinions of
respondents regarding the phenomenon being studied”. Descriptive research provides
an accurate portrayal or account of the characteristics of a particular individual event, or
group in real-life situations for the purpose of discovering new meaning, describing what
exists, determining the frequency with which something occurs, and categorising
information (Burns & Grove 2005:734). Descriptive studies provide valuable baseline
information. The method is also flexible and can be used to collect information from a
large group of respondents (Drummond 1998:31). In this study, the researcher
attempted to identify and describe factors that contributed to the high pregnancy rate
among adolescents in the Kinondoni area.
3.4.4 Exploratory descriptive research design
According to Brink (2006:102), an exploratory descriptive research design has the
following characteristics:
•
It is a flexible research design that provides an opportunity to examine all aspects
of the problem being studied.
•
It strives to develop new knowledge.
•
The data may lead to suggestions or hypotheses for future studies.
•
It is usually a field study in a natural setting.
3.5
RESEARCH POPULATION AND SAMPLE
Polit and Beck (2004:50) define a population as “the totality of all subjects that conform
to a set of specifications, comprising the entire group of persons that is of interest to the
researcher and to whom the research results can be generalized”. LoBiondo-Wood and
Harber (2002:242) describe a sample as “a portion or a subset of the research
population selected to participate in a study, representing the research population”.
39
3.5.1 Population
A population is the aggregate or totality of all subjects or members that conform to a set
of specifications (Babbie 2005:190; Polit & Hungler 1999:37). The population in this
study comprised all adolescent girls aged between 10 and 19 years, from Kinondoni
Municipality.
Eligibility criteria specify “the characteristics that people in the population must possess
in order to be included in the study” (Polit & Beck 2004:290). To be included in this
study, the respondents had to:
•
Be adolescent girls between 10 and 19 years old.
•
Reside in the selected two sub-wards in Manzese ward, namely Midizini and
Mnazimmoja.
•
Be willing to participate in the study.
•
Give informed consent.
3.5.2 Sampling and sample
3.5.2.1
Sampling techniques
A multistage sampling (cluster sampling) method was employed in this study. A
multistage sampling is a sampling strategy that proceeds through a set of stages from
larger units to smaller sampling units or clusters; it can be from states to nursing
schools, to faculty members (Polit & Hungler 1999:707).
A list of all 27 wards was obtained from the Kinondoni Municipal Council and one ward
randomly selected by picking a number, which happened to be Manzese ward. Then
two sub-wards were randomly selected again from a list of sub-wards/streets in the
selected ward, and these were Midizini and Mnazimmoja. All adolescents aged 10 to
19, in the selected sub-wards were included in the study.
3.5.2.2 Sample size
The sample size was calculated using the following formula:
40
n = Z2pq
d2
Where n = Minimum sample size required
Z = Percentage point of the normal distribution corresponding to the level of
significance. For 5% level of significance, Z =1.96.
P = Proportion of pregnant adolescents in the population taken to be 20%. This is from
Tanzania census done by (NBS 2000:38).
Q = 1- p
D = maximum likely error (taken to be 0.05)
N = (1.96)2 (0.2) (0.8)
(0.05)2
Sample size = 245.86 = 246
3.6
DATA COLLECTION
Polit and Beck (2004:32) define data as “information obtained during the course of an
investigation or study”. In this study, a questionnaire was used to obtain data relevant to
the objectives and questions. The purpose of the study was to identify the factors that
might contribute to the high adolescent pregnancy rate to prevent unplanned
pregnancies.
3.6.1 Data-collection instrument
Data-collection instruments refer to devices used to collect data such as questionnaires,
tests, structured interview schedules and checklists (Brink 2006:296). Polit and Beck
(2004:729) define a questionnaire as “a method of gathering information from
respondents about attitudes, knowledge, beliefs and feelings”. The questionnaire was
designed to gather information about adolescents’ knowledge, attitudes and beliefs
regarding pregnancy.
After an in-depth literature review, the researcher designed the questionnaire with the
supervisor, joint supervisor and a statistician. The final questionnaire was discussed
with the guidance of the supervisor, statistician and midwifery experts, and accepted in
41
terms of face and content validity. According to Babbie (2005:244), a questionnaire is “a
document containing questions designed to solicit information appropriate for analysis.
Usually it is information from respondents about their attitudes, knowledge, beliefs and
feelings.”
3.6.1.1
Characteristics of a questionnaire
Brink (2006:300-304) states that the following aspects characterise a questionnaire:
•
Each participant enters his/her responses on the questionnaire, saving the
researcher’s time, compared to the time required to conduct personal interviews.
•
It is less expensive than conducting personal interviews.
•
Respondents’ feel that they remain anonymous and can express themselves in
their own words without fear of identification. This aspect was very important in
this study where the adolescents might not have wished their mothers, friends or
healthcare workers to know about their knowledge, attitudes and beliefs
concerning pregnancy.
•
Data on a broad range of topics may be collected in a limited period.
•
The format is standard for all subjects and independent of the interviewer’s
mood.
3.6.1.2
Development of the questionnaire
The researcher derived the questions from the literature review (see chapter 2), from
the researcher’s personal observations, and from consultation with a nurse tutor
experienced in adolescent sexual and reproductive health.
The questionnaire was
given to two independent experts, two experienced Midwifery tutors at the School of
Nursing, to evaluate the face and content validity as well as that the conceptual
components of the questionnaire accurately reflected the factors that might contribute to
the high adolescent pregnancy rate. The questionnaire was corrected and discussed
with the statistician, the language editor and the researcher’s supervisors from Unisa
and Muhimbili University College of Health Sciences. Polit and Hungler (1999:419)
emphasise that experts on the content should be called upon to analyse the adequacy
of items representing the topic under study.
42
The reviewers supported the assertion that the components of the questionnaire
accurately reflected the essence of the concepts being studied and that the questions
were appropriate to the factors contributing to the high pregnancy rate in Kinondoni
Municipality.
The questionnaire was typed and translated into Kiswahili, the local
language. An expert in English language translation edited the translation and certified
that the same meanings were conveyed by specific items in the English and in the
Kiswahili versions of the questionnaire (see Annexure D).
3.6.1.3
Structure of the questionnaire
The questionnaire consisted of four sections:
Section A:
Biographical information
Section B:
Sexuality and reproductive health issues
Section C:
Source of information
Section D:
Effects of pregnancy on respondents
The items contained in the questionnaire, comprising both open-ended and closed
questions, attempted to identify the factors contributing to the high pregnancy rate in
Kinondoni Municipality.
3.6.1.4
Administration of the questionnaire
The researcher made appointments with the Medical Officer in charge of Kinondoni
municipality and the ten cell leaders of the sub-wards. Then the researcher went to the
selected institution that is Kinondoni municipality in person. The administrators provided
the researcher with the names and contact details of the ten cell leaders, who assisted
with the whole process.
The researcher explained the nature and purpose of the study to the potential
respondents, informed them that participation was voluntary, and asked them to
participate in the study. Every respondent willing to participate received a consent form
with information about the study to sign. After giving informed consent, the respondents
were taken to a private room and given writing materials. The researcher, assisted by
four volunteers from the school of nursing, handed out the questionnaires on the
43
specific data-collection days in January 2007. To minimise response bias, the
researcher remained outside the room, but within reach to clarify problems, if the need
arose. Two hundred and three girls completed and returned questionnaires. The
completed questionnaires were handed to a statistician for data capturing and analysis.
3.6.1.5
Advantages of a questionnaire
The advantages of using a questionnaire in this study were as follows:
•
Questionnaires were less expensive to administer than conducting interviews, as
interviews might have required hiring and training interviewers/field workers.
•
As the researcher was not present during the completion of the questionnaires,
there was no researcher bias, as could occur during interviews.
•
The respondents’ anonymity was ensured during data collection by not writing
their names on the questionnaires, so that the findings could not be linked to any
respondent.
•
The respondents felt safe, as they were not facing the researcher during
completion of the questionnaire.
•
Time was saved during data collection, as the completion of the questionnaire
required about 30 minutes, and all the respondents could complete their
questionnaires simultaneously on the specific day (LoBiondo-Wood & Harber
2002:303-304).
3.6.2 Reliability and validity
3.6.2.1
Reliability
Polit and Hungler (1999:411) describe the reliability of a tool as the consistency with
which the tool measures the attribute it is supposed to measure. If a study and its
results are reliable, other researchers using the same method will obtain the same
results. A pre-test was conducted with respondents similar to the study sample, but
excluded from the actual study, to determine the clarity of the items and consistency of
the responses (LoBiondo-Wood & Haber 2002:319).
44
3.6.2.2
Validity
According to Babbie (2005:143), validity refers to “the extent to which an empirical
measure adequately reflects the real meaning of the concept under consideration”.
Validity can be sub-categorised as external and internal validity.
Burns and Grove (2005:218) describe external validity as “the extent to which the
results can be generalised beyond the sample used in the study. This usually depends
on the degree to which the sample represents the population.” Low external validity in
this study implies that the results can apply only to adolescent in the two sub-wards in
Manzese ward (Lo-Biondo-Wood & Harber 2002:197). The external validity of this study
may have been compromised as there was no guarantee that the respondents had
similar knowledge, attitudes and beliefs regarding pregnancy.
Internal validity is the extent to which factors influencing adolescent pregnancy are a
true reflection of reality rather than the result of the effects of extraneous or chance
variables, not necessarily related to factors influencing pregnancy.
3.7
ETHICAL CONSIDERATIONS
Nurses face ethical dilemmas in their daily duties, as do researchers, when people are
used as study respondents in an investigation. First, the researcher obtained written
permission to conduct the study and to use the Community Centre facilities for data
collection from the Medical Officer In-charge of Kinondoni Municipal Council and the
Chairman: Muhimbili University College Research and Publications, and (see Annexure
B). Informed consent was obtained from the respondents and, to avoid researcher bias,
the administrators selected the contact persons to assist with organising the
respondents at the venue.
Researchers need to exercise care that the rights of individuals and institutions are
safeguarded (Brink 2006:31-35).
In this study, the researcher observed the ethical
principles of beneficence, respect for human dignity, fair treatment, self-respect,
protection of human rights, benefit and honesty in data processing.
45
3.7.1 Beneficence
The principle of beneficence encompasses freedom from harm and exploitation (LoBiondo Wood & Harber 2002:270). No physical harm resulted from completing
questionnaires, but some psychological discomfort might have resulted from the nature
of some of the questions. The researcher’s telephone numbers were provided should
any respondent wish to discuss any aspect. The researcher would have referred
respondents who experienced psychological discomfort as a result of completing the
questionnaires to a counsellor, but no respondents indicated or expressed discomfort.
3.7.2
Respect for human dignity
Respect for human dignity includes the right to self-determination and to full disclosure
(Pera & Van Tonder 2005:46). The respondents’ right to self-determination was
honoured because they
•
could decide independently, without any coercion, whether or not to participate in
the study
•
had the right not to answer any questions that caused discomfort
•
could disclose or not disclose personal information
•
could ask for clarification about any aspect that caused some uncertainty
The right to full disclosure was respected because the researcher described the nature
of the study as well as the respondents’ rights to participate or refuse to participate in
the study. This was included in the informed consent (see Annexure C).
Each respondent voluntarily signed a consent form. The signed consent form was
folded and placed in a box prior to completion of the questionnaire. Each completed
questionnaire was placed in a separate container. No signed consent form could be
linked to any specific questionnaire. This ensured the respondents’ anonymity.
Confidentiality was maintained because no names were disclosed in the research
project. Any respondent who wished to obtain the findings could contact the researcher
(Polit & Beck 2004:151).
46
3.7.3
Self-respect
The respondents’ right to maintain self-respect and dignity were observed through
protection from physical and psychological risk during the study. Neither participation
in, nor withdrawal from the study was attached to any future care to be given
adolescents. No one could benefit from participation or be harmed by refusal to
participate in the study (Polit & Beck 2004:142).
3.7.4
Benefit
The respondents were informed that they would receive no monetary benefit from
participating in the study. The findings could benefit the health providers in formulating
health education guidelines that will enhance better life styles for adolescents in
Kinondoni (Burns & Grove 2005:194).
3.7.5
Protection of human rights
The researcher explained the nature and purpose of the study and the type of
information required to the respondents. The respondents all clearly understood and
then gave informed consent (Burns & Grove 2005:181).
3.7.6
Fair treatment
In this study all the respondents were fairly selected and treated, the researcher
selected the respondents according to the research problem of adolescent pregnancies.
3.7.7
Data processing
Regarding data processing, the researcher adhered to the principle of honesty with
regard to data. No data were fabricated and data were keyed into the computer as
presented by respondents and then analysed, using the SPSS V13.0 computer
program. The researcher involved a qualified statistician to ensure that the statistical
calculations were applicable to the type of data.
47
3.8
PRE-TESTING THE RESEARCH INSTRUMENT
A pre-test or pilot study is a small-scale trial of the data collection instrument to
determine clarity of questions and whether the instrument elicits the desired information
(Polit & Beck 2004:296). In order to ensure reliability and validity, the questionnaire was
pre-tested on ten teenagers with similar attributes in Temeke Municipality to check the
clarity of questions and identify vague or non-acceptable questions. Adjustments were
made based on the outcome of the pre-test results. The data collected during the pretest was not part of the study. All the participants completed the questionnaire within 30
minutes and understood the questions.
3.9
DATA ANALYSIS
The data was analysed using the SPSS V13.0 software computer program by a
statistician at Muhimbili University of Health and Allied Sciences. Descriptive statistics,
frequency tables and percentages, were used in the data analysis and interpretation.
3.10
CONCLUSION
This chapter discussed the research design and methodology of the study. The
researcher used a quantitative, descriptive, exploratory design and a questionnaire as
data-collection instrument. Chapter 4 describes the data analysis and interpretation.
48
Chapter 4
Data analysis and interpretation
4.1
INTRODUCTION
This chapter presents the data analysis and interpretation. A statistician analysed the
data, using the Statistical Package for SPSS V13.0. The statistics are presented in
frequencies, tables and percentages. Relationships between variables were identified
using frequencies and percentages, the researcher collected data from the
respondents using structured questionnaires, which had four sections:
•
Section A: Biographic information
•
Section B: Sexual and reproductive health issues
•
Section C: Source of information
•
Section D: Effects of pregnancy on the respondents
A total of 203 respondents participated in the study voluntarily. They were informed
about the aim of the study, the details in the consent forms, and why it was important
for them to participate. Then they signed the consent forms, and the consent forms
were collected before distribution of questionnaires and were kept separate from the
completed questionnaires to ensure anonymity. This made it impossible to link the
two.
The respondents were divided into small groups and each group had an assistant
researcher, who went through each question and let the girls respond as they saw fit.
In items where not all the respondents responded, the frequency and percentages
were calculated according to the number of responses, as in item 7. Missing
responses were thus not included.
The findings are discussed in numerical sequence, according to the format of the
questionnaire.
49
4.2
SECTION A: BIOGRAPHICAL INFORMATION
The biographical information included age; religion; tribe; place of stay; who they lived
with; respondents’ educational level, and that of their parents/guardians; respondents’
occupational and economic status, and that of their parents/guardians. Though this
information was not central to the study, the personal data helped to contextualise the
findings and the formulation of reproductive heath programmes to meet the needs of
adolescent girls.
4.2.1 Item 1: Respondents’ age
The respondents’ ages were within the reproductive age group of adolescents 10-19
years. Figure 4.1 depicts the respondents’ ages.
0.5%
28.2%
31.2%
10-13 yrs
14-16 yrs
17-19 yrs
Not indicated
40.1%
Figure 4.1
Respondents’ age (n=203)
According to figure 4.1, the respondents were between 10 and 19 years old, which is
within the WHO’s definition of adolescence. The age range of 10 to19 years is
characterised by profound biological, psychological, and social developmental
changes (Sadock & Sadock 2003:35).
50
Figure 4.1 indicates that of the respondents, 31.2% (n=63) were 10 to 13 years old
(early adolescence); 40.1% (n=81) were 14 to 16 years old (middle adolescence),
28.2% (n=57) were 17 to 19 years old (late adolescence), and 0.5% (n=2) did not
answer the question. The majority of the respondents were in middle adolescence.
4.2.2
Item 2: Respondents’ religion
Of the respondents, 70.0% (n=142) were Muslims, 28.1 %( n=57) were Christians and
1.5% (n=3) indicated neither Muslim nor Christian. This means that the area where
the study was done comprises mainly Moslems, which is typical of the coastal area in
this country. In this study, then, the respondents represented Muslims, Christians and
other/no religion. This means that the research results might be generalised to
adolescents in Kinondoni.
4.2.3
Item 3: Respondents’ educational level
It was important for the researcher to determine the respondents’ level of education,
as education influences individuals’ decisions regarding reproductive issues. Table 4.1
depicts the respondents’ educational level.
Table 4.1
Respondents’ educational level (n=202)
LEVEL OF
EDUCATION
No formal
education
Primary education
Secondary
education
TOTAL
NON-PREGNANT
FREQUENCY
PERCENT
3
1.7
PREGNANT
FREQUENCY
PERCENT
1
4.8
135
74.5
16
76.2
43
23.8
4
19.0
181
100.0
21
100.0
TOTAL
4
2.0%
151
74.7%
47
23.3%
202
100.0%
Of the respondents, 74.7% (n=151) were attending/attended primary education; 2.0%
(n=4) had no formal education, and 23.3% (n=47) were attending/had secondary
education. By comparison between the pregnant and non-pregnant respondents,
1.7% (n=3) non-pregnant and 4.5% (n=1) pregnant had no formal education; 74.5%
(n=135) non-pregnant and 76.2 (n=16) pregnant had primary education; 23.8% (n=43)
51
non-pregnant and 19.0% (n=4) pregnant had secondary education. This indicated that
most of the respondents had primary education, which is vital to their lives. At this age
they need formal/non-formal education and health education in reproductive health
issues in order to shape their future. Further/higher education for adolescents would
likely delay child bearing.
In Tanzania, Muchuruza (2000:48) found that the level of education was associated
with the risk of pregnancy; the risk increased among those with no formal education
compared to those with secondary education.
In this study the educational level was mostly primary education. Of the respondents,
68% (n=138) between 14 and 19 years were expected to be in secondary school, but
only 23.6% (n=48) were. Of the respondents, 31.2% (n=63) were between 10 and13
years old and in primary school. This indicates that many adolescents do not have the
chance to continue with secondary school education, which would enable them to be
knowledgeable and protect themselves from unwanted pregnancy and STIs, including
HIV/AIDS.
Educated women are more likely to delay child bearing. In some countries in SubSaharan Africa, many women with less than primary education have a child before
they are 18, compared to those with seven or more years of education. Therefore
education enables women to be self-reliant and is a protective measure against
pregnancy. A low level of education is associated with teenage pregnancy (Fraser et
al 2006:51).
4.2.4 Item 4: Respondents’ occupational status
The respondents’ occupation was very important to the researcher since the main
occupation at that age should be schooling (see table 4.2).
52
Table 4.2
OCCUPATION
Students/pupils
Respondents’ occupation (n=203)
NON-PREGNANT
FREQUENCY
PERCENT
107
58.8
PREGNANT
FREQUENCY
PERCENT
2
9.50
Petty business
14
7.7
9
42.85
No occupation
28
15.4
9
42.85
No response
33
18.1
1
4.80
182
100.0
21
100.0
TOTAL
TOTAL
109
53.7%
23
11.3%
37
18.2%
34
16.7%
203
100.0%
According to table 4.2, 58.8% (n=107) of the non-pregnant respondents were
students/pupils, 7.7% (n=14) were doing petty business (including casual labourers,
house girls and small business), and 15.4% (n=28) had no occupation. Of those who
were pregnant, 9.5% (n=2) had agreed to being pregnant while still in school; 42.85%
(n=9) were doing petty business, and 42.85% (n=9) had no occupation.
Table 4.2 indicates that 53.7% (n=109) of the respondents were still attending school
(students/pupils), while more than 30% (n=29) were already out of school, either
having completed primary education or as school dropouts. Of the respondents,
16.7% (n=38) who did not mention their occupations were most probably dropouts
from school.
The economic status of the respondents who were out of school is low, in accordance
with what they were doing. They had nothing tangible to manage life because they
had not obtained enough education for employment and some were jobless. This put
them at risk of involving themselves in undesirable behaviour. In Tanzania there are
very limited formal employment opportunities, particularly for youth and especially
girls, adolescents are growing up in an economy that is not able to fulfil their
expectations. Inadequate services and economic hardship have led to the increase of
adolescent high-risk situations such as unwanted pregnancies and early child bearing,
STIs, including HIV/AIDS, and drug abuse (RCHS 2004a:1).
53
4.2.5 Item 5: Respondents’ marital status
Here the researcher wished to establish the respondents’ marital status, as it would
indicate the level of early marriage in the society. Of the respondents, 2.3% (n=5)
stated that they were married. In some societies in Tanzania, early marriage is
accepted and allowed for the reason that a girl who has reached puberty is an adult
woman and therefore ready for marriage; it will save their daughters from engaging in
promiscuity, and alleviate the poverty of the family (MOE and VT 2006a:35).
The researcher is of the opinion that the respondents who were married had been
deprived of their education. Marriage at this age is a risk factor to adolescents since
their bodies are still developing, and they have to depend on the partner for the rest of
their lives to meet the challenges of being mothers and wives unless they go to school
again. Nasoro (2003:30) maintains that parents should be educated on the importance
of striving for the education of their female children and postpone their marriage until
they are at least 20 or older.
4.2.6 Item 6: Who respondents live with
Table 4.3 represents the respondents’ replies to who they reside with.
Table 4.3
Who respondents live with (n=203)
LIVING WITH …
Both parents
NON-PREGNANT
FREQUENCY
PERCENT
105
57.7
PREGNANT
FREQUENCY
PERCENT
6
28.6
Father only
11
6.0
1
4.7
Mother only
39
21.4
6
28.6
Guardian
21
11.5
3
14.3
Husband
2
1.1
3
14.3
No
permanent
place
No response
1
0.6
1
4.7
3
1.7
1
4.7
182
100.0
21
100.0
TOTAL
54
TOTAL
111
54.7%
12
5.9%
45
22.2%
24
11.8%
5
2.5%
2
1.0%
4
2.0%
According to table 4.3, of the respondents, 54.7% (n=111) lived with both parents;
5.9% (n=12) lived with their fathers only; 22.2% (n=45) lived with their mothers only;
11.8% (n=24) lived with guardians, and living with husbands were 2.5% (n=5). About
2.0% (n=4) did not answer this question. Of those who were pregnant, 28.6% (n=6),
lived with both parents; 28.6% (n=6) lived with their mothers only, and 4.7% (1) lived
with her father. Most of the respondents, non-pregnant and pregnant, were living with
both parents, followed by those with mothers only. This indicated that most of the
families were still “intact” and the respondents had both parents with them. In addition,
the majority of the pregnant respondents (57.2%) lived with their mothers (probably
single parents) or with both their parents.
4.2.7 Item 7: Respondents’ parents/guardians educational and economic status
The researcher wished to establish the parents/guardians’ educational and economic
status, which could influence the respondents’ lives (see tables 4.4 to 4.6).
Table 4.4
Respondents’ fathers’ level of education (n=149)
EDUCATIONAL
LEVEL
No formal
education
Primary education
Secondary
education
Higher education
TOTAL
Table 4.5
NON-PREGNANT
FREQUENCY
PERCENT
11
8.1
PREGNANT
FREQUENCY
PERCENT
3
21.4
TOTAL
14
57
53
42.2
39.3
8
2
57.1
14.3
65
55
14
135
10.4
100.0
1
14
7.1
100.0
15
149
PREGNANT
FREQUENCY
PERCENT
4
28.6
TOTAL
Respondents’ mothers’ level of education (n=157)
EDUCATIONAL
LEVEL
No formal
education
Primary education
Secondary
education
Higher education
TOTAL
NON-PREGNANT
FREQUENCY
PERCENT
12
8.4
16
73
51
51.0
35.7
8
2
57.1
14.3
81
53
7
143
4.9
100.0
14
100.0
7
157
55
Table 4.6
Respondents’ guardians’ level of education (n=24)
EDUCATIONAL
LEVEL
No formal
education
Primary education
Secondary
education
Higher education
TOTAL
NON-PREGNANT
FREQUENCY
PERCENT
2
10.0
PREGNANT
FREQUENCY
PERCENT
2
50.0
TOTAL
4
10
5
50.0
25.0
1
-
25.0
-
11
5
3
20
15.0
100.0
1
4
25.04
100.0
4
24
According to tables 4.4, 4.5 and 4.6, of the respondents’ fathers, 43.6% (n=65) had
primary education; 36.9% (n=55) had secondary education; 10.0% (n=15) had higher
education, and 9.4% (n=14) had no formal education. With regard to the respondents’
mothers’ educational status, 51.6% (n=81) had primary education; 33.7% (n=53) had
secondary education; 4.5% (n=7) had higher education, and 10.2% (n=16) had no
formal education.
The respondents parents’/guardians’ educational level did not differ. Most of the
parents and guardians were not highly educated. This might have hindered the
respondents’ educational progress.
Tables 4.7 and 4.8 indicate the respondents’ fathers’ and mothers’ occupational
status.
Table 4.7
OCCUPATION
Unemployed
Employed
Self-employed
TOTAL
Table 4.8
OCCUPATION
Unemployed
Employed
Self-employed
TOTAL
Respondents’ fathers’ occupational status (n=183)
NON-PREGNANT
FREQUENCY
PERCENT
28
17.0
59
35.0
78
47.3
165
100.0
PREGNANT
FREQUENCY
PERCENT
3
16.7
5
27.8
10
55.6
18
100.0
TOTAL
31
64
88
183
Respondents’ mothers’ occupational status (n=186)
NON-PREGNANT
FREQUENCY
PERCENT
44
26.5
31
18.7
91
54.8
166
100.0
56
PREGNANT
FREQUENCY
PERCENT
3
15.0
5
25.0
12
60.0
20
100.0
TOTAL
47
36
103
186
More respondents gave information about their parents’ occupations than about their
education. Table 4.7 indicates that of the respondents’ fathers, 53.3% (n=88) were
self-employed; 38.8% (n=64) were employed, and 18.8% (n=41) were unemployed.
According to table 4.8, of the mothers, 62.0% (n=103) were self-employed; 21.7%
(n=36) were employed, and 28.3% (n=47) were unemployed. In this area, selfemployment meant small-scale businesses, like small (“spaza”) shops, selling
raw/cooked food items along the road, or in marketplaces.
The study found that most of the fathers had the same occupation as their spouses.
For those who were unemployed, the partner might have been employed or doing
business. Most of the businesses were small scale, which did not sustain the family
needs and their economic status was low. According to the MOE and VT (2006a:21),
some pupils are forced to supplement their home income or buy some of their own
requirements due to their parents’ poor economic status.
4.3
SECTION B: SEXUALITY AND REPRODUCTIVE HEALTH ISSUES
4.3.1 Item 8: Respondents’ age at first menstrual period (menarche)
Out of the 203 respondents, 71.4% (n=145) indicated that they already had their
menstrual periods. Out of the 71.4%, 62.8% (n=91) started menstruating at the age of
13, while some were as young as 9 years old at menarche. Figure 4.2 illustrates the
ages at which the respondents had their first menstrual period.
57
70
62.8
60
Percent
50
40
30
17.9
20
11.1
10
2.1
2.4
9
10
4.8
0
11
12
13
14+
Age (years)
Figure 4.2
Respondents’ age at menarche (n=144)
Knowing the age at which the respondents’ had their first menstrual period would
determine when reproductive health education should be given. Sexual and
reproductive health education would empower adolescents with knowledge and life
skills about the changes occurring in their bodies, and reproductive health issues. The
purpose would be to postpone sexual intercourse and reduce the occurrence of STIs
and pregnancy. Menarche is a factor contributing to adolescent pregnancies.
Regarding contraceptive awareness and use, Dlamini et al (2003:79) and Nasoro
(2003:25) found that the age of menarche was 11 to 15 and was associated with
increased sexual activity, which put teenagers at risk of unwanted pregnancy and
STIs.
4.3.2
Item 9: Respondents’ age at first sexual encounter (debut)
Of the respondents, 28.6% (n=58) answered this question. Table 4.9 indicates that
28.6% (58) of the respondents had engaged in sexual intercourse, and 65.5% (n=38)
had done so at the age of 15 to 17 years. According to the NBS (2000:37; 67-68),
58
about 15% of women aged between 15 and19 had sexual intercourse for the first time
by the age of 15; by 18, 65% of women were already sexually active, and by 20, about
86% were already sexually active.
Table 4.9
Respondents’ age at first sexual encounter (n=58)
YEARS
12
13
14
15
16
17
18
19
Not indicated
TOTAL
FREQUENCY
1
2
5
13
14
11
7
2
3
58
PERCENT
1.70
3.45
8.60
22.40
24.10
19.00
12.10
3.45
5.20
100.00
This study found that the respondents were sexually active around their first menstrual
period, which implied that there was an association between the age at menarche and
that at first sexual intercourse. This could possibly be because in late adolescence
girls are better at making decisions. Furthermore, this indicated the importance of
reinforcing health education at this age about changes in their bodies, sexual
intercourse, pregnancy, contraception and abstaining from sexual intercourse.
Adolescents have a right to information on reproductive health and services, as the
information will delay pregnancy and risk factors associated with sexual intercourse
and pregnancy.
4.3.3
Item 10: Respondents’ reasons for sexual debut
The researcher wished to determine the respondents’ reasons for sexual debut in
order to identify the factors leading to sexuality in adolescent girls so that they can be
helped. Table 4.10 presents the respondents’ reasons.
59
Table 4.10
Respondents’ reasons for sexual debut (n=58)
REASONS
Self-desire
Peer pressure
Parent pressure
Pressure of partner
To get pregnant
Other reasons
Not indicated
TOTAL
FREQUENCY
16
20
1
14
1
3
3
58
PERCENT
27.6
34.5
1.7
24.1
1.7
5.2
5.2
100.0
According to table 4.11, several reasons led the respondents to have sexual
intercourse. Of the respondents, 34.5% (n=20) indicated peer pressure; 24.1% (n=14)
indicated partner pressure; 27.6% (n=16) indicated self-desire, and 1.7% (n=1) stated
parental pressure; 5.2% (n=3) did not indicate any reasons and 5.2% (n=3) reported
other reasons for sexual debut.
Mwaba (2000:30-34) found that the main reason (66.0%) for sexual debut was the
pressure exerted by boys/men on girls to have sexual intercourse. Cuesta (2001:180192) found that among 21 pregnant teenagers, the pregnancy occurred in the context
of a genuine love affair, although they had not intended to fall pregnant.
According to Ehlers (2003:19), the reasons for sexual debut included: “did not know”
or “it just happened” (8); were asked or coerced by partner (8); loved their partner (6);
were curious (5), or succumbed to peer pressure (4). In Nigeria, the RCHS (2004a:5)
and Irinoye et al (2004:27) found that some mothers encouraged their sons into
sexual activity to be “real men”, and asked the boys if something was wrong if there
was no sign of relationship with girls.
Given the above findings, the researcher is of the opinion that boys and men, parents
and adolescents themselves should be involved in strategies to reduce adolescent
pregnancies.
60
4.3.4
Item 11: Respondents’ pregnancy
4.3.4.1
Item 11.1: Age at first pregnancy
Of the 203 respondents, only 23.2% (n=21) stated that they had been pregnant. Of the
respondents, 4.8% (n=1) stated that they had first been pregnant at the age of 15;
23.8% (n=5) at 16; 19.1% (n=4) at 17; 23.8% (n=5) at 18; 14.3% (n=3) at 19, and
14.3% (n=3) did not answer the question. (See table 4.1 for educational level of
respondents who fell pregnant.)
Most adolescents’ pregnancies occurred in Grades 4 to 7 of their primary schooling.
These are among the 5% to 7% of dropouts at primary level due to pregnancy
(Ministry of Education and Culture 2005:21-25).
Figure 4.3 depicts the respondents’ age at first pregnancy.
25
23.8
23.8
19.1
20
14.3
14.3
19
Not indicated
Percent
15
10
5
4.8
0
15
16
17
18
Age (years)
Figure 4.3
Respondents’ age at first pregnancy (n=21)
According to figure 4.3, of the respondents 66.7% (n=14) fell pregnant between 16
and 18 years of age.
61
4.3.4.2
Item 11.2: Pregnancies planned or unplanned
Of the 21 respondents, 90.2% (n=19) stated that they had not planned the pregnancy,
and 9.8% (n=2) had planned to fall pregnant. In a study on risk factors for teenage
pregnancy among sexually active black adolescents in Cape Town, Vundule et al
(2001:73-80) found that 97.4% (n=191) of pregnancies were not planned.
Despite the guidelines on sexual and reproductive services developed for
adolescents, the phenomenon is still surrounded by stigma, especially among parents,
community and religious leaders, service providers and programmes. Consequently,
adolescents are still denied access to reproductive health services. Existing services
are not adolescent friendly in terms of type and quality of services offered, time of
service, location and affordability. Expertise is lacking in schools.
In short,
adolescents have not benefited in spite of favourable policies and guidelines being
formulated (RCHS 2004a:12).
4.3.5
Item 12: Respondents’ information about abortion
4.3.5.1
Item 12.1: Respondents who had an abortion (n=203)
The respondents were asked if they had had an abortion and 2.9% (n=6) stated that
they had had an abortion.
4.3.5.2
Item 12.2: Where abortion was conducted
Of the respondents, 83.3% (n=5) stated that the abortions were conducted at a clinic,
and 16.7% (n=1) stated at home. The low results may have been due to sensitivity of
the question, because available hospital-based data suggest that young women in
Tanzania are more likely to undergo unsafe abortions than older women, possibly
because of limited access to reproductive health services. More adolescents suffer
from abortion-related morbidity and mortality than those in the child-bearing age of 18
to 35 (NCCDPHP 1999:57-61; RCHS 2004a:3).
62
4.3.5.3
Item 12.3: Should girls aged 10-19 have a legal abortion or not
The respondents were asked to indicate whether young girls aged 10 to 19 should
have a legal abortion. Of the respondents, 70.9% (n=144) stated that they should not;
16.3% (n=33) stated that they should be allowed to abort; and 12.8% (n=26) did not
answer the question.
This study found only a small percentage of the respondents had had an abortion.
They and all adolescents, therefore, need reproductive health services to rescue them
from the ill-effects of abortion.
4.3.6 Item 13: Respondents’ knowledge on reproductive health issues
Several questions were asked to measure respondents’ level of knowledge on
pregnancy and reproductive health issues. It was important to identify the knowledge
on reproductive health issues at that particular age in order to give them life skills that
will enable them to continue with further education eventually to get a career and earn
a living.
4.3.6.1
Item 13.1: When is a woman likely to fall pregnant
Respondents were asked when is a woman likely to get pregnant, 0f the respondents
21.1% (n=41) indicated 14 days before menstruation; 19.2% (n=39) indicated14 days
after menstruation; 6.9% (n=14) indicated during menstruation; 27.6% (n=56)
indicated any time; and majority 26.1% (n=53) did not respond to this question. This
means that the knowledge of when a woman is likely to get pregnant is low. Dlamini et
al (2003:78) found that adolescents practise unsafe sex and were not aware that they
could become pregnant and/or contract HIV/AIDS.
63
4.3.6.2
Item 13.2: Risk age for an adolescent to fall pregnant
Of the respondents, 92.1% (n=187) stated that they were not aware of the risk age;
5.4% (n=11) stated that they were aware, and 2.5% (n=5) did not answer the
question.
4.3.6.3
Item 13.3: Appropriate age for an adolescent to fall pregnant
Of the respondents, 80.3% (n=163) showed 20 years and above, 17.2% (n=35)
indicated age below 20, and 2.5% (n=5) did not answer the question.
4.3.6.4 Item 13.4: Right time for a girl to receive information about reproductive
health issues
Of the respondents, 78.3% (n=159) that information about reproductive health issues
should be given during primary education; 11.3% (n=2) stated that during secondary
school while 4.4% (n=9) mentioned that at higher education level. In Tanzania sexual
and reproductive health is taught in schools, but it is inadequate in content and
methods, particularly due to scarcity of IEC materials. Schools also are not equipped.
Teachers receive insufficient training in reproductive health issues. In spite of
developing National policy guidelines for reproductive health services, many young
people have not benefited from them, due to low coverage of targeted audience, and
other critical constraints such as limited resources and cultural barriers (RHCS
2005:10).
Table 4.11
Respondents’ recommendations on when to receive reproductive
health information (n=203)
TIME
Primary school
Secondary school
Higher education
Not indicated
TOTAL
FREQUENCY
159
23
9
12
203
PERCENT
78.3
11.3
4.4
6.0
100.0
Most of the respondents, 78,3% (n=159) stated that reproductive health information
should be given during primary school; this shows their readiness to get the
information and that they find it appropriate. The MOE and VT in Tanzania have
64
included Reproductive health in their curriculum of primary education as indicated
previously. In addition, the MOE and VT (2006a:17) has developed a guide for
schools and Teachers’ College to widen their knowledge on guidance and counselling,
which includes various problems faced by students in and outside the school, such as
reproductive health issues, sexuality, pregnancies, drug abuse and truancy.
It is expected that adolescents should have high knowledge and parents should be
knowledgeable as they are the first teachers to their adolescent girls. Parents should
also talk openly at home about these issues in order to prevent adolescent
pregnancies, sexually transmitted disease including HIV/AIDS. In addition in a study
done by Mwaba (2000:16-34) and Vundule et al (2001:73-80) found that most
teenagers had negative attitudes towards pregnancy as 77% girls and 85% boys
regarded it as wrong, and 92.7% of the girls said they wanted to complete school.
4.3.6.5 Item 13.5: Respondents’ knowledge of contraception
Several questions were asked to measure the respondents’ knowledge and
awareness on contraceptives. The respondents were asked about the use of
contraceptives in order to identify their awareness and use. Of the respondents,
10.8% (n=22) stated that they used contraceptives; 57.6% (n=117) indicated non-use,
and 31.5% (n=64) did not answer the question. The methods used by those who
stated to be using contraceptives were pills 45.5% (n=10) mentioned pills, 27.3%
(n=6) mentioned injectables, while 13.6% (n=3) mentioned condoms. Of the
respondents who indicated using contraceptives, 13.6% (n=3) did not answer this
question (see table 4.12). Ehlers (2003:19) found that among the respondents who
used contraceptives, (16) stated to be using injectables, condoms (16) and pills (5).
65
Table 4.12 Respondents’ use of contraceptives (n=22)
METHOD
Pills
Injectables
Condoms
Not indicated
TOTAL
4.3.6.6
FREQUENCY
10
6
3
3
22
PERCENT
45.5
27.3
13.6
13.6
100.0
Item 13.6: Suitable contraceptive methods for adolescents
Of the 203 respondents, 62.6% (n=127) mentioned condoms, pills and injectables;
8.9% (n=18) indicated the voluntary surgical contraception. Thus 71.4% (n=145)
responded to this question and 28.6% (n=58) did not answer the question.
4.3.6.7
Item 13.7: Methods that prevent pregnancy and STDs
Of the respondents, 52.7% (n=107) stated condoms; 23.2% (n=47) indicated
intrauterine devices, pills, and natural methods, and 24.1% (n=49) did not answer the
question.
Based on the above statistics the adolescents seem to know about condoms, but do
not use them. Williams and Mavundla (1999:62) found a high rate of unprotected sex.
Among 42 teenage mothers only 2.4% used condoms. Although they acknowledged
the use of condoms to be the safest method, they did not use them.
This could be due either to lack of knowledge of general reproduction issues or
negative attitudes towards contraceptives. Young adolescents are less likely to use
contraceptives because of their immaturity. Lack of knowledge on methods of
contraception was revealed among teenagers aged 15 – 19 as the reason of not using
contraceptive method (N’gwalida 2001:29; Mbambo, Ehlers & Monerang 2006:26-29).
66
4.3.6.8
Item 13.8: How to prevent pregnancy, STDs and HIV
Of the respondents, 67.5% (n=137) stated that by abstaining from sexual activities;
21.7% (n=44) mentioned other contraceptive methods such as using contraceptives,
having regular medical check-up, having only one sexual partner; and 10.8% (n=22)
did not answer the question.
Pardue (2003:1) found that ”increased abstinence was the major cause of declining
birth and pregnancy rate among single teenage girls”. Most striking among these
findings is that among unmarried teenage girls aged 15 to 19 increased abstinence
accounted for 67 percent of the decrease in pregnancy rate. Similarly, a 51 percent of
the drop in the birth rate for single teenage girls 15 to 19 is attributed to abstinence
(http://www.heritage.org./Research/Family).
This indicates that adolescents can be encouraged to postpone sexuality and
pregnancy by abstaining, and those who cannot abstain should be encouraged to use
contraceptives.
4.4
SECTION C: SOURCE OF INFORMATION
Different sources of knowledge regarding sexuality and reproduction were presented
to the respondents on the questionnaire. They were asked on the source of
knowledge that contributed more towards the knowledge they have.
4.4.1 Item 14: Respondents’ source of information regarding menstruation
The information from the girls regarding menstrual period was important to the
researcher in order to identify the role of parental care in avoiding adolescent
pregnancies.
67
Other relatives
21.1
Friends
18.8
Nurse
18.7
44.3
Teacher
11.8
Father
58.1
Mother
0
10
20
30
40
50
60
70
Percent
Figure 4.4
Respondents’ source of knowledge regarding menstruation
According to figure 4.4, of the respondents 58.1% (n=118) indicated their mothers as
the source of information concerning menstruation; 11.8% (n=24) mentioned their
fathers; 44.3% (n=90) mentioned teachers; 18.7 %( n=38) indicated the nurses as the
source of information; 18.8% (n=37) mentioned their friends, and 21.1% (n=43)
indicated relatives.
According to the findings the researcher is of the opinion that; parents, school
teachers, nurses and relatives and the community should be involved in providing
information about changes during puberty so that adolescents are prepared well to
face the challenges at that time.
4.4.2 Item 15: Respondents’ source of information about sexuality and
reproduction
Different sources of knowledge regarding sexuality and reproduction were presented
to the respondents on the questionnaire. They were asked about the source of
knowledge that contributed more towards the knowledge they have. The information
68
regarding knowledge on sexuality was important to identify those who contributed
more and the deficit in relation to equipping the adolescents with knowledge
necessary for their development.
Table 4.13
Respondents’ source of information on sexuality and reproduction
(n=203)
WHO
PROVIDED
INFORMATION
School
Parents
Friends
Television/video
Newspapers
Internet
Church/Mosque
MOST
LEAST
NONE
MISSING
TOTAL
99 (48.7%)
75 (36.9%)
35 (17.2%)
44 (21.7%)
41 (20.2%)
21 (10.3%)
19 (9.3%)
34 (16.8%)
31 (15.3%)
40 (19.7%)
54 (26.6%)
39 (19.2%)
20 (9.8%)
17 (8.4%)
30 (14.8%)
44 (21.7%)
47 (23.1%)
34 (16.7%)
40 (19.7%)
65 (32.0%)
54 (26.6%)
40 (19.7%)
53 (26.1%)
81 (39.9%)
71 (35.0%)
81 (39.9%)
97 (47.8%)
113 (55.7%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
In relation to source of information about sexuality and reproduction, 48.7% (n=99) of
the respondents stated that they have received information about sexuality and
reproduction from school; 36.9% (n=75) mentioned receiving information from parents;
17.2% (n=35) indicated that their friends provided the information; 21.7% (n=44)
indicated from television/video; 20.2% (n=41) mentioned newspapers; 10.3% (n=21)
stated Internet; while 9.3% (n=19) mentioned church/mosque.
4.4.3 Item 16: Respondents’ source of knowledge about pregnancy
Respondents were asked about different sources who contributed more to the
knowledge they have on pregnancy. The aim is the same as the one mentioned
above.
Table 4.14
WHO
PROVIDED
INFORMATION
School
Parents
Friends
Television/video
Newspapers
Internet
Church/Mosque
Respondents’ source of information about pregnancy (n=203)
MOST
LEAST
NONE
NO
RESPONSE
TOTAL
130 (64.0%
76 (37.4%)
41 (20.2%)
46 (22.7%)
40 (19.7%)
17 (8.4%)
17 (8.4%)
20 (9.8%)
30 (14.8)
40 (19.7%)
46 (22.7%)
36 (17.7%)
22 (10.8%)
12 (6.0%)
15 (7.4%)
25 (12.3%)
31 (15.3%)
27 (13.3%)
33 (16.3%)
60 (29.6%)
63 (31.0%)
38 (18.7%)
72 (35.5%)
91 (44.8)
84 (41.3%)
94 (46.3%)
104 (51.3%)
111 (54.5%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
203 (100.0%)
69
Of the respondents, 64.0% (n=130) indicated school as the source of information;
37.4% (n=76) stated parents; 20.2% (n=41) indicated friends; 22.7% (n=46) indicated
television/video; 19.7% (n=40) stated newspapers; 8.4% (n=17) indicated the Internet,
and 8.4% (n=17) indicated others.
In general, from the above tables: 4.16; 4.17 and 4.18, parents and the community are
not participating in educating their children about reproductive and sexuality issues, it
might be because they feel not well educated, that youths are more educated in the
end their parents feel not empowered to do so. Parents should play a significant role
as sexuality educators for their children. Many parents are not ready to discuss with
their children, they assume that their youths will get information from school (Khoza
2004:39; Miller 2002:22 -26). According to a report by Linda (2003:7), it was indicated
that among the strategies to reduce teen pregnancy is an approach that involves
education, health, social services, the media, parents and most importantly the young
people themselves, (http://www.info.doh.gov.uk)
4.5
SECTION D: EFFECTS OF PREGNANCY ON ADOLESCENT
4.5.1 Item 17: Respondents’ knowledge of the effects of pregnancy on the
adolescent
They were also asked about the health problems that could be expected when an
adolescent falls pregnant (see figure 4.5).
70
Anaemia
19.7
5.9
Depression
STI/HIV infection
6.9
14.3
Premature labour
5.9
Miscarriage
29.1
High blood pressure
0
5
10
15
20
25
30
35
Percent
Figure 4.5
Respondents’ knowledge of effects of pregnancy on adolescents (n=203)
Respondents were asked about problems/effects of pregnancy on the adolescents. Of
the respondents 29.1% (n=59) mentioned blood pressure; 5.9% (n=12) stated
miscarriage; 14.3% (n=29) stated premature labour; 6.9% (n=14) mentioned
STI/HIV/AIDS infection; 5.9% (n=12) mentioned depression, and 19.7% (n=40) stated
anaemia.
From the figure 4.5 above it shows that adolescents are not knowledgeable about the
effects of pregnancy on their health, as only few responded on this question.
Therefore it is important to educate the adolescents at this age about effects of
pregnancies on adolescents and their consequences.
In addition they were asked about social problems that are prevalent with an
adolescent pregnancy almost all adolescents were aware of the social impact on
teenage pregnancies, that one will suffer from lack of money and parents will abandon
them. Furthermore, they stated that being abandoned by friends and shame were not
their big issue.
71
4.5.2 Item 18: What the respondents would like to learn more about
The respondents were asked to indicate what they would like to learn more about. The
responses were coded and categorised into four groups in order of importance:
•
Reproductive health issues
•
STDs
•
Early sexuality and abortion and their consequences
•
Abstinence and how to overcome temptation
This study found the source of knowledge limited. Most of the respondents indicated
school as the source of knowledge, and other sources were poorly ranked. In the
researcher’s view, much effort is still needed to empower adolescents with the
necessary information. The findings indicated that the respondents had little
knowledge, obtained mainly in primary school, and from their parents and other
sources. They need to continue with secondary education as a means of becoming
knowledgeable and self-reliant, and contributing to the country’s development.
4.6
CONCLUSION
This chapter discussed the data analysis and interpretation, with the use of
frequencies, tables and diagrams.
Chapter 5 concludes the study and presents recommendations for reducing the
factors contributing to the high adolescent pregnancy rate in Kinondoni Municipality.
72
Chapter 5
Findings, limitations and recommendations
5.1
INTRODUCTION
The purpose of the study was to describe the factors that contribute to the high
adolescent pregnancy rate in Kinondoni Municipality to prevent unplanned pregnancies.
This chapter discusses the conclusions and limitations of the study and makes
recommendations for strategies to improve the services to adolescent girls and further
research.
5.2
FINDINGS
5.2.1 Age
Of the respondents, 31.2% were 10 to 13 years old; 40.1% were14 to 16, and 28.2%
were 17 to 19, hence the majority were in middle adolescence.
5.2.2 Religion
In regard to religious affiliation, 70.0% of the respondents were Muslims, 28.1% were
Christians, and 1.5% were neither Muslims nor Christians.
5.2.3 Educational level
Most of the respondents (74.7%) were literate (see chapter 4, table 4.1). The
respondents’ educational level was mostly primary education, which meant that many of
them did not have the chance to continue with secondary school education, as only
23.3% were in secondary schools. Secondary or high school education is important
because it can equip adolescents to be knowledgeable; protect themselves from
unwanted pregnancies and STDs, including HIV/AIDS; enable them to be self-reliant
and self-supporting, and contribute to the national economy and alleviating poverty.
73
The study found that most of the respondents had a low level of education. A low level
of education is associated with teenage pregnancy.
5.2.4 Occupational status
Of the respondents, 53.7% were attending either primary school or secondary school,
30% were not going to school, and 16.7% did not answer this question (see chapter 4,
table 4.2). Of the respondents who had been pregnant (85.0%), 42.85% were doing
petty business and 42.85% had no occupation. These were dropouts, and more than
30% of the respondents were at risk because their educational level was not high
enough to get a useful career and earn a living.
In Tanzania, there are very limited formal employment opportunities, particularly for
youth and especially girls. Inadequate services and economic hardship have led to
increased adolescent risk situations, such as unwanted pregnancies and early child
bearing, STIs, including HIV/AIDS, and drug abuse (RCHS 2004a:1).
Based on the above, school attendance and becoming educated are very important at
this age. Adolescents who are not at school are at risk of being dependants or involving
themselves in sexual activity to meet their needs (see table 4.9). Adolescents therefore
need reproductive health services, education and guidance.
5.2.5 Marital status
Of the respondents, only 2.3% stated that they were married. Marriage during
adolescence is a high-risk situation because their bodies are still developing and the
consequences and outcome of pregnancy are frequently unfavourable. In addition, they
have been deprived of an education that could have equipped them to earn a
reasonable living.
5.2.6 Who living with
This study found that of the respondents, 54.7% lived with both parents; 5.9% lived with
their fathers only; 22.2% lived with their mothers only; 2.5% lived with their husbands,
74
and 1.0% did not have a permanent place to stay (see table 4.3). Of the pregnant
respondents, 57.3% lived with their mothers or with both parents.
5.2.7 Parents’/guardians’ educational and economic status
The study found the respondents’ parents’/guardians’ educational level generally low.
According to the respondents’ fathers, 43.6% had primary education; 36.9% had
secondary education; 10.0% had higher education, and 9.4% had no formal
education. With regard to the respondents’ mothers’ educational status, 51.6% had
primary education; 33.7% had secondary education; 4.5% had higher education, and
10.2% had no formal education.
The respondents’ parents had a low economic status (see tables 4.7, 4.8). Of the
fathers, 18.8% were unemployed; 38.8% were employed, and 53.3% were selfemployed. Of the mothers, 28.3% were unemployed; 21.7% were employed, and 62.0%
were self-employed. Self-employment in this area meant small-scale business, like
small (“spaza”) shops, and selling raw/cooked items along the road or in small markets.
The population are generally poor because their incomes are small.
5.2.8 Age at first menstrual period
Of the respondents, 71.4% were already menstruating. Of these, 62.8% started
menstruating at age 13, and some started at as young as 9.
5.2.9 Age at first sexual encounter
With regard to the first sexual encounter, 28.6% of the respondents had engaged in
sexual intercourse. Of these, 65.5% had engaged in sexual intercourse at 15 to 17
years of age.
5.2.10 Reason for sexual debut
The respondents gave the following reasons for their sexual debut: self-desire (27.6%);
peer pressure (34.5%); pressure from partner (24.1%); parent pressure (1.7%); to fall
75
pregnant (1.7%), and “other” reasons which led to sexual intercourse, although no
reason was given (5.2%).
5.2.11 Pregnancy
Of the respondents, 23.2% had been pregnant, and most (66.7%) of them fell pregnant
between 16 and18 years of age.
Of the respondents who fell pregnant, 90.2% stated that they did not plan to fall
pregnant, and 9.8% had planned to fall pregnant.
5.2.12 Abortion
Of the respondents, 2.9% had had an abortion. Most of them (83.3%) had had the
abortion at a clinic, and 16.7% had had it at home.
In relation to whether girls aged 10 to19 should have a legal abortion or not, 70.9% of
the respondents stated that girls should not be allowed to have an abortion, while 16.3%
were in favour of girls being allowed to have an abortion. In this study, the respondents
did not plan to have an abortion
5.2.13 Knowledge of reproductive issues
With regard to when a woman is likely to fall pregnant, 21.1% of the respondents
indicated 14 days before menstruation; 19.2% stated 14 days after menstruation; 6.9%
indicated during menstruation; 27.6% indicated any time, and 26.1% did not answer the
question. This indicated that the respondents were not knowledgeable about time of
conception.
When asked about the risk age for an adolescent to fall pregnant, 92.1% were not
aware and 5.4% were aware.
In relation to the appropriate time for a woman to fall pregnant, 80.3% indicated 20
years and older, and 17.2% stated younger than 20. These two items indicated that the
respondents had little or poor knowledge of the consequences of adolescent pregnancy.
76
In relation to right time for adolescents to receive information about reproductive health
issues, 78.3% of the respondents indicated at primary school; 11.3% stated at
secondary or high school, and 4.4% stated at higher (tertiary) education level. The
majority of the respondents, therefore, were ready to receive information at the
appropriate time during primary education. Accordingly, the researcher feels strongly
that it is the responsibility of all key players to take their role as educators, counsellors,
and care givers of adolescents seriously.
In this study the respondents were aware that condoms as contraceptive method
prevents STDs, HIV/AIDS infection and pregnancy. Nevertheless, condoms were not
regularly used (see table 4.12). Of the respondents, 57.6% indicated non-use; 10.8%
were using contraceptives, and 31.5% did not answer the question. The methods used
were pills (45.5%); injectables (27.3%); condoms (13.6%), and 13.6% did not answer
the question. In relation to the most suitable contraceptive method for adolescents:
62.6% stated condoms and 8.9% indicated pills and injectables. Regarding methods
that prevent pregnancy and STIs, 52.7% stated condoms, and 23.2% indicated
intrauterine devices, pills and natural methods.
In order to prevent pregnancy, STIs and HIV/AIDS, 67.5% indicated abstaining from
sexual activity; and 21.7% indicated using contraceptive methods, regular medical
check ups, having one sexual partner; and having only one partner.
The respondents knew that abstaining from sexual intercourse is a way of preventing
adolescent pregnancies and STIs, but many factors contribute to these pregnancies.
5.2.14
Source of knowledge of reproductive issues
In this study, their mothers were the main source of information on menstruation, and
school was the main source about pregnancy, sexuality and reproductive health issues
(see figure 4.4; tables 4.13 and 4.14).
Of the respondents, 58.1% indicated their mothers as the source of information about
menstruation; 11.8% indicated their fathers; 44.3% indicated teachers; 18.7% indicated
nurses; 18.8% stated friends, and 21.1% stated relatives.
77
With regard to the source of information about sexuality and reproduction, 48.0% stated
indicated the school; 36.9% said their parents; 17.2% said friends; 21.7% said
television/radio; 20.2% said newspapers; 10.3% said the Internet, and 9.3% said
church/mosque.
With regard to the respondents’ source of information about pregnancy, 64.0% indicated
school; 37.4% indicated parents; 20.2% indicated friends; 22.7% said television/radio;
19.7% indicated newspapers; 8.4% said the Internet, and 8.4% indicated others
5.2.15
Knowledge of effects of pregnancies on adolescents
The respondents were asked about the effects of pregnancies on adolescents (see
figure 4.5). Of the respondents, 29.1% indicated blood pressure; 5.9% stated
miscarriage; 14.3% indicated premature labour; 6.9% stated STI/HIV/AIDS infection;
5.9% stated depression, and 19.7% indicated anaemia. The findings indicated little
knowledge of the effects and consequences of pregnancy on adolescents. The
respondents were unaware of the consequences of adolescent pregnancy, but were
aware of the social problems that are prevalent with adolescent pregnancy.
Adolescents have a right to information, including the effects and consequences of
adolescent pregnancies that might make them postpone sexual activity.
5.2.16 What the respondents wanted to know more about
The respondents generally indicated that they wished to know more about:
•
Reproductive health issues
•
STIs
•
Early sexuality, abortion and their consequences
•
Abstinence and how to overcome temptation
From the findings, it is clear that adolescents are not getting adequate information and
sexuality education hence their needs are not met. The low response to nurses as
source of information indicated that the respondents were not in regular contact with the
medical personnel (nurses), possibly because they did not have access to the
78
reproductive health services or the services were not user friendly. This would appear to
indicate that more deliberate strategies are needed.
The parents and the community did not appear to be playing their roles in educating the
children about reproductive and sexuality issues. Again, it seemed that they were not
knowledgeable and empowered to do so.
5.3
LIMITATIONS OF THE STUDY
The researcher identified the following limitations in the study. The study was limited to
the factors contributing to the high adolescent pregnancy rate in Kinondoni Municipality
therefore the findings cannot be generalised to the entire country. This imposed a
further limitation on the generalisability of the research results, as it cannot be assumed
that the respondents who participated in the study had the same knowledge, attitudes
and perceptions regarding reproductive health services as those who did not participate.
5.4
RECOMMENDATIONS
Based on the findings of this study, the researcher makes the following
recommendations for practice and for further research.
5.4.1 Ministry of Education and vocational training
•
Deliberate efforts should be made to ensure that as many girls as possible
continue with secondary education, especially because of being at risk.
•
Vocational training should be provided for adolescents with no formal education
and those with primary/secondary education only (dropouts) to occupy them and
develop a future.
•
Teachers should be equipped to counsel students, in primary and secondary
schools, using counselling skills they learned at teachers’ college.
79
•
Girls should receive education about menstruation, sexual intercourse,
pregnancy and contraceptives before they reach the age of 13 when a number of
them have already had their menarche and some even their sexual debut.
5.4.2 Community support system
•
The parents/guardians need to be equipped with knowledge and skills regarding
reproductive health issues, so that they can communicate with their children
adequately. Parents are the first educators of their children, and should use
religion to teach moral and ethical issues to abstain from or postpone sexual
activity. It is therefore important for the community and individual families to
improve the quality of life of their families and their economic status.
•
Community centres should be used to provide information for the youth on
reproductive health issues, including dramas, seminars and workshops.
5.4.3 Health services management
•
Reproductive health services should be accessible to, friendly and affordable for
adolescents.
•
Develop sustainable reproductive health programmes and implement the
programmes at all clinics. The programmes should be audited at regular
intervals.
•
Health care workers should be sensitive to the needs of adolescents by creating
supportive environments and programmes to prevent and address the causes of
adolescent pregnancies.
5.4.4 The country
•
The government, NGOs and private sector should continue to endeavour to
improve and encourage the economy.
80
•
The media should be actively involved in providing information to the community
on the prevention of adolescent pregnancy, and STI/HIV/AIDS infection.
•
Develop country partners in Africa to generate new knowledge and develop
systematic guidelines at programme and policy level.
5.4.5 Further research
Further research should be conducted on the following topics:
•
Parents’ occupational and economic status as factors contributing to adolescent
pregnancies
•
An investigation into parents’ knowledge with regard to sexual education of their
children
•
Contraception awareness and use among adolescents who are sexually active
•
What male partners can contribute to the prevention of adolescent pregnancy
•
A survey on school dropouts.
•
Sexuality education, gender and reproductive issues related to changes during
puberty for girls.
5.5
CONCLUSION
Adolescent pregnancies are still a major health concern in Tanzania, Africa and
elsewhere. Teenage mothers’ socio-economic advancement, education and job
opportunities are limited and stunted by premature pregnancy. The study found that
poor economic status of parents, low educational level, lack of knowledge/information
on reproductive health issues and pressure from men, were the main factors
contributing to the high adolescent high pregnancy rate in Kinondoni Municipality,
Tanzania.
81
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88
fI-
.. ~
<...
'. .
Mrs. Margaret N. Philemon
School of Nursing Diploma
P.O. Box 65003
DAR ES SALAAM.
19th December,
2006
The District Medical Officer
Kinondoni Municipal Council
P.O. Box 61615
DAR ES SALAAM.
U.f.s. Director,
hAlV/J~'/)5~
.po A AS$;'/.5''7''A NC~
Institute of Allied Health Sciences
MUCHS.
DIRECfO
INSTITUTE
Dear
RE:
Sir,
J/, //1:t,2./2aJE,
ALLJED HEAL 1:1-1SCI':"'Ch~
Muhiabiti Univcrsiry College of Hc:klt.bScica~
REQUEST TO CONDUCT RESEARCH IN MANZESE WARD
ON "FACTORS CONTRIBUTING TO HIGH ADOLESCENT
PREGNANCY RATE IN KINONDONI MUNICIPALITY"
I am a Nurse Tutor at the above school, at the moment I am pursuing a
Masters degree in Advanced Midwifery with the University of South Africa
as a Distance Learner. The research is done to fulfill the requirements
of
the degree.
My research study is "Factors contributing to the adolescent
pregnancy rate in Kinondoni Municipality Dar es Salaam".
high
The study aims to identify and describe the factors that contribute to
high rate of adolescent pregnancies. The proposed problem will benefit
the community of kinondoni municipal in the following;
In terms of the findings strategies that provide information to adolescents
and accessibility and user friendly of Reproductive health care clinics for
adolescents in Kinondoni Municipality.
In order to achieve the objectives of the study, relevant information
needed through distributing
questionnaires
to adolescents;
is
.'
a
. ...~.
'<
it.,
Pregnant and non pregnant have been selected to participate
study. Manzese ward has been randomly selected.
in this
The distribution
of Questionnaires
will be done during morning hours.
Ethical consideration
will be adhered to at all times. The proposed date
for data collection shall be in December/January
2006.
I hope my request
shall be favourably
Please find enclosed
MUCHS.
Thanking
my proposal
you in advance
considered.
and Ethical clearance
for your co-operation
Sincerely,
~9f)
Mrs. M. Philemon
~
-'._-;-
~
~.
~.
,,
~,-.,.. -:,~'-.~"_..
+-
~:;
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.i'_
letter from
..
KINONDONI MUNICIPAL COUNCIL
ALL CORRESPONDENCES
Tel:
SHOULD BE DIRECTED TO THE MUNICIPAL DIRECTOR
2171022
In reply please quote:
MUNICIPALMEDICAL OFFICER
OF HEALTH.
KINONDONIMUNICIPALCOUNCIL
P.O. BOX 61665,
DAR ES SALAAM
Ref. No. FD/KJl33
Date: 4TH junuary
VI 145
2007
TO WHOM IT MAY CONCERN:
KlNONDONI MUNICIPALITY.
RE: RESEARCH PERMIT
MARGRETH PHILEMON
The above mentioned is a research student from MUCHS school of nursing school has been
given permit to conduct a research in your ward on factors contributing to high adolescent
pregnancy rate in Kinondoni Municipality, from 8thJanuary to 23rd January 2007.
Kindly provide her with the necessary assistance in order to enable her to perform her
activities comfortably.
Best wishes,
.~l;l-.......
Aleswa Zebedayo
(Research Coordinator.)
Kinondoni Municipal Council
Copy: To above mentioned Candidate.
NB: please give a feedback to MMOH office after completing your research.
KINONDONI MUNICIPAL COUNCIL
ALL CORRESPONDENCES
Tel:
SHOULD BE DIRECTED TO THE MUNICIPAL DIRECTOR
2171022
In reply please quote:
MUNICIPALMEDICALOFFICER
OF HEALTH,
KINONDONIMUNICIPALCOUNCIL
P.O. BOX 61665,
DAR ES SALAAM
Ref. No. FD/K/ 133 VI 145
Date: 4THjunuary 2007
TO WHOM IT MAY CONCERN:
KINONDONI MUNICIPALITY.
RE: RESEARCH PERMIT
MARGRETH PHILEMON
The above mentioned is a research student from MUCHS school of nursing school has been
given permit to conduct a research in your ward on factors contributing to high adolescent
pregnancy rate in Kinondoni Municipality, from 8thJanuary to 23rdJanuary 2007.
Kindly provide her with the necessary assistance in order to enable her to perform her
activities comfortably.
Best wishes,
~~........
Alesw~'ayo
(Research Coordinator.)
Kinondoni Municipal Council
Copy: To above mentioned Candidate.
NB: please give a feedback to MMOH office after completing your research.
,,'
MUHIMBILI UNIVERSITY COLLEGE
A
,'. 1#
4.
#
OF HEALTH SCIENCES
OFFICE OF THE DIRECTOR OF RESEARCH AND PUBLICATIONS
P. O. BOX65001
.
.
DAR ES SALAAM
TELEPHONE: Direct: 255222152489
TANZANIA
Telegrams: UNIVMED
Telex: 41505 MUHMEDTZ
Telefax: 25522-150465
E-mail:[email protected]
Ref.No.MU/RP/ AECN oLIX/26
3rd January,
2006
Mrs. Margaret Philemon,
Diploma School of Nursing,
Institute of Allied Health Sciences,
MUCHS.
RE: APPRO VAL OF ETHICAL CLEARANCE FOR THE STUDY TITLED "FACTORS
CONTRIBUTING
TO HIGH ADOLESCENT
PREGNANCY
RATE IN
KINONDONI
MUNICIPALITY, DAR ES SALAAM"
Reference is made to your submission requesting for ethical clearance for the abovementioned study.
I am pleased to inform you that the Chairman has on behalf of the Academic Board
approved Ethical Clearance of your study. The ethical clearance is in effect for one year,
from 29thDecember, 2006 - 28th December, 2007.
of this letter, ethical clearance is granted to proceed with planned activities.
~.F.Ly
C~AN,
Y
MITTEE
COLLEGE RESEARCH & PUBLICATIONS COM
c.c. Pr~cipal, MUCHS.
c.c. Registrar, MUCHS.
c.c. Director, Institute of Allied Health Sciences, MUCHS.
'~""'"
.
.
..
..'<:\
1
Annexure C (KIAMBATANISHO NAMBA C)
KISWAHILI “VERSION OF CONSENT FORM”
FOMU YA IDHINI
NAMBA YA UTAMBULISHO
Maombi ya kupata idhini kushiriki katika zoezi hili, kwa kujibu maswali katika
dodoso unayopewa.
Habari! Mimi ninaitwa Bibi Margareth Philemon, ni mwalimu muuguzi na
ninachukuwa shahada ya uzamili ya ukunga.
Sababu za utafifi:
Tunaendesha ufafiti huu ili kugundua ni mambo yapi yanayosababisha kupata
mimba kwa wingi katika umri mdogo.
Iwapo utashiriki:
Utapewa
karatasi
yenye
maswali
na
maelezo
kuyajibu,utachangia mawazo yako katika suala hili.
nawe
utatakiwa
Usiri:
Majibu yote utakayotoa yatakuwa siri, jina lako halitatumika, bali nambari yako tu
ndiyo itaingizwa kwenye kompyuta
Iwapo itatokea hatari:
Hatutegemei hatari/yeyote kutokea/kukupata kwa sababu ya kushiriki katika
utafiti huu.
Uhuru wa kushiriki au kutoshiriki:
Kushiriki au kujiondoa katika utafiti huu ni hiari yako kabisa, ukiamua kutoshiriki,
wahudumu wa afya wataendelea kukuhudumia kama kawaida. Una uhuru wa
kuacha wakati wowote, hata kama ulikubali mwanzoni, kukataa kwako au
kujiondoa katika utafiti hakutaathiri haki yako ya kupata huduma unayostahili.
Faida ya kushiriki :
2
Ukikubali kushiriki katika utafiti huu, itakuwa ni faida kwako kutoa elimu/maarifa
mawazo yako katika mchakato wa kutafuta njia mbadala za kuyashughulikia
masuala ya vijana wa kike ili wapate huduma itakayowasaidia wasipate ujauzito
katika umri mdogo.
Iwapo yatatokea madhara :
Hatutegemei madhara yeyote kutokea kufauatana na wewe kushiriki. Iwapo
madhara yatatokea kufuatana na wewe kushiriki katika utafiti huu, utahudumiwa
kufuatana na mwongozo uliopo wa matibabu hapa nchini Tanzania. Hutapata
matibabu ya ziada.
Nani wa kumwona/kuwasiliana naye:
Iwapo utakuwa na maswali kuhusiana na utafiti huu wasiliana na mtafiti Mkuu –
Bibi Margareth Philemon wa Taasisi ya Vyuo Vya Vyeti na Stashahada ya juu,
Muhimbili S.L.P 65003, DAR ES SALAAM. Iwapo utakuwa na wasiwasi juu ya
haki zako kuhusu utafiti huu wasiliana na Prof. E. Lyamuya, Mwenyekiti wa
Kamati ya Utafiti na Uchapishaji Chuo Kikuu Kishiriki cha Muhimbili, S.L.P 65001
DAR ES SALAAM Simu Nambari 2152489.
Sahihi:………………………
Je unakubali?
Mshiriki amekubali…………………..Mshiriki amekataa………………….
Mimi,…………………………….Nimesoma maelezo katika dodoso hili. Maswali
yangu yamejibiwa.Ninakubali kushiriki katika utafiti huu.
Sahihi----------------------------------Sahihi ya shahidi( kama hajui kusoma)----------------------Sahihi ya Mtafiti msaidizi.-------------------------------------Tarehe ya kupata idhini-----------------------------------
1
Annexure
C
CONSENT FORM:
INFORMED CONSENT
ID–NO
Consent: To participate in sharing of your experience on the factors,
contributing to high adolescent pregnancy rate, through filling in the prepared
questionnaire.
Hello! My name is Mrs. Margareth Philemon, I am a nurse tutor. I am pursuing
Masters in advanced studies in midwifery.
Purpose of Study
I am conducting a study in Kinondoni municipal Council in order to learn about
factors contributing to high adolescence pregnancy rate. By knowing these
factors we can enhance the accessibility and user friendly of health care clinics
for adolescents in Kinondoni municipal.
What participation Involves
If you agree to join in the study, you will be required be given a questionnaire
whereby you will answer questions thereon and so share your knowledge on the
issue.
Confidentiality
All information we collect on forms will be entered into computers with only the
study identification number.
Risks
I do not expect that any harm will happen to you because of joining this study. It
is only the information you are giving and you will not be associated with that
information after you have given it.
Rights to withdraw and Alternative.
Taking part in this study is completely you choice. If you choose not to participate
in this study you will continue to receive all services that you would normally get
from the clinic. You can stop participating in this study at any time, even if you
have already given your consent. Refusal to participate or withdrawal from the
study will not involve penalty or lose of any benefits to which you are otherwise
entitled.
2
Benefits
If you agree to take part in this study, the study gives you a chance to participate
in reflecting on adolescent problems. You and other adolescent girls will benefit
in receiving appropriate health care after the results are out.
In case of Injury
We do not anticipate that any harm will occur to you as a result of participation in
this study. How ever if any physical injury resulting from participation in this
research should occur, we will provide you with medical treatment according to
the current standard of care in Tanzania. No additional compensations.
Who to Contact
If you ever have questions about this study, you should contact the Principal
Investigator, Mrs. M. Philemon. Institute of Allied Health Sciences, P.O. Box
65003, Dar es Salaam. If you ever have questions about your rights as a
participant, you may call Prof. E.F. Lyamuya, Chairman of the College Research
and Publications Committee, P.O. BOX 65001, Dar es Salaam. Tel. 2152489
Signature: …………………
Do you agree?
Participant
agree…………..
agrees
……………………
Participant
does
NOT
I, ________________________have read the contents in this form. My questions
have been answered. I agree to participate in this study.
Signature ____________________________
Signature of witness (if Adolescent Cannot read) ___________________
Signature of research assistant ____________________________
Date of Signed consent_________________________
1
Annexure D
DODOSO YA UTAFITI
UTAFITI KUHUSU MAMBO YANAYOSABABISHA
MIMBA KATIKA UMRI WA MIAKA 10-19 KATIKA
HALMASHAURI YA KINONDONI, DAR ES SALAAM
Jibu maswali yote kwa kuweka alama ya ‘v’ katika kisanduku au andika
jibu katika sehemu iliyowazi,maswali mengine yana majibu zaidi ya moja
NAMBA YA DODOSO
1
2
3
SEHEMU A: TAARIFA BINAFSI:
MATUMIZI
YA OFISI
1. Je una miaka mingapi kamili sasa?
4
Miaka
2. Unaishi wapi?
……………………………………………………
3. Je dhehebu/dini lako/yako ni lipi/ipi katika haya?
3.1 Muislamu
1
3.2 Mkristo (Mprotestant)
2
3.3 Mkatoliki
3
3.4 Mengineyo(taja)
4
4. Je wewe ni kabila gani?
…………………………………………….
5. je umewahi kwenda shule?
NDIYO HAPANA
1
2
6. Kama ni ndiyo kiwango chako cha elimu ni kipi?
6.1 Elimu ya Msingi (darasa la…….)
6.2 Elimu ya Sekondari (darasa……..)
7. Unaishi na nani?
1
2
5
6
7
8
9
2
7.1 Wazazi wote wawili
7.2 Baba pekee
7.3 Mama pekee
7.4 Mume
7.5 Mlezi
7.6 Sina makazi ya kudumu (taja wapi?)…….
8. Kiwango cha juu cha elimu cha Wazazi/Walezi
Baba Mama
8.1
8.2
8.3
8.4
1
2
3
4
5
6
10
Mlezi
Hajasoma
Elimu ya msingi (darasa la……)
Elimu ya sekondari (darasa la…)
Elimu ya juu
9. Hali yako ya ndoa ni ipi?
9.1 Sijaolewa
9.2 Nimeachika
9.3 Nimeolewa
9.4 Nimefiwa na mume
9.5 Sijaolewa naishi na bwana
10. Kama umeolewa ni sababu zipi zilikupelekea kuolewa?
10.1 Nililazimishwa na wazazi
10.2 Nilipenda mwenyewe
10.3 Sikuwa na wa kumtegemea
10.4 Nilipata mimba
10.5 Sababu nyinginezo (taja)
11. Baba/Mlezi anafanya shughuli gani?
11.1 Hajaajiriwa
11.2 Ameajiriwa
11.3 Amejiajiri (Mfanyabiashara)
12 Je Mama/Mlezi anafanya shughuli gani?
12.1 Hajaajiriwa
12.2 Ameajiriwa
12.3 Amejiajiri (Mfanyabiashara)
1
2
3
4
1
2
3
4
5
1
2
3
4
5
1
2
3
1
2
3
13. Je wewe unajishughulisha na nini?
…………………………………………………………
14. Je shughuli unayoifanya inatosheleza mahitaji yako?
NDIYO
HAPANA
1
2
11
12
13
14
15
16
17
3
SEHEMU B: MASUALA KUHUSU AFYA YA UZAZI NA UJINSIA
15. Ni mabadiliko gani yanayotokea wakati wa kubarehe wasichana?(
ibu ni zaidi ya moja)
15.1 Kuota mavuzi
15.2 Kuongezeka matiti
15.3 Kuvunja ungo
15.4 Mengineyo (taja)
16. Je umevunja ungo?
1
2
3
4
NDIYO
1
HAPANA
2
17. Kama ni ndiyo ulivunja ungo ukiwa na miaka mingapi?
17.1 Miaka 8
1
17.2 Miaka 9
2
17.3 Miaka 10
3
17.4 Miaka 11
4
17.5 Miaka 12
5
17.6 Miaka 13
6
17.7 Mingineyo (taja)
7
18. Ulipewa taarifa gani ulipovunja ungo?
18.1 Kwamba hiyo ni laana
1
18.2 Utapata maumivu
2
18.3 Uko tayari kupata mtoto
3
18.4 Uko tayari kuolewa
4
18.5 Ujitahidi kuwa msafi
5
18.6 Ujiepushe na ngono
6
18.7 Mengineyo (taja)
7
19. Katika hawa/hivi nani wa/kilikupa taarifa kuhusu elimu ya uzazi?
NDIYO
HAPANA
1
2
19.1 Mama
19.2 Baba
19.3 Mwalimu
19.4 Muuguzi
19.5 Rafiki
19.6 Ndugu wengine
19.7 Majarida
19.8 Vitabu
19.9 Mengineyo (taja)
20. Je ni kipindi gani mwanamke anaweza kupata mimba?
20.1 Siku 14 kabla ya kuingia mwezini
1
20.2 Siku 14 baada ya kuingia mwezini
2
18
19
20
21
22
4
20.3 Siku za kuwa mwezini
20.4 Wakati wowote
21. Je ulishawahi kufanya tendo la ngono?
Kama ni hapana nenda swali nambari 25
NDIYO
1
22.Je ulikuwa na umri gani ulipofanya tendo la ngono?
3
4
HAPANA
2
23
24
25
Miaka
23. Je unakumbuka ni nini kilikusababisha wewe kufanya ngono?
23.1 Hamu ya kufanya ngono
1
23.2 Ushawishi wa wenzangu
2
23.3 Ushawishi wa wazazi
3
23.4 Nililazimishwa na mhusika
4
23.5 Kutafuta mimba
5
23.7Sababu nyinginezo
6
24. Je mtu uliyefanya naye ngono kwa mara ya kwanza alikuwa na umri
gani?
26
27
Miaka
25. Je una wapenzi wangapi wa ngono sasa?
28
26. Je ulishawahi kuwa na Wapenzi wa ngono wangapi?
29
27 Ni athari zipi unazozijua zinazotokana na kujiingiza kwenye
mapenzi/ngono katika umri mdogo? (jibu ni zaidi ya moja)
27.1 Kushindwa mtihani
1
27.2 Kupata mimba
2
27.3 Kupata magonjwa ya zinaa
3
27.4 Jamii itakudharau
4
28. Je unatumia dawa/mpango wa wowote wa kuzuia mimba?
NDIYO
HAPANA
Kama hutumii nenda nambari 29
1
2
29.Unatumia dawa/njia ipi/zipi katika kati ya hizo kuzuia mimba?
29.1 Vidonge
29.2 Sindano
29.3 Njia za asili
1
2
3
30
31
32
5
29.4 Nyinginezo (taja)…………………………….
30. Kama hutumii toa sababu
…………………………………………………
…………………………………………………
4
33
31. Ni njia ipi/zipi zinafaa kwa vijana?
31.1 Kufunga kizazi
1
31.2 Vidonge
2
31.3 Sindano
3
31.4 Mpira wa kiume/kike
4
32. Je ni wapi utazipata/zinapatikana hizo njia za kuzuia mimba?
32.1 Duka la dawa
1
32 Sokoni
2
32.3 Kliniki za uzazi wa mpango
3
32.4 Shuleni
4
32.5 Kwingineko (taja)
5
33. Ni njia ipi inayozuia kupata mimba na magonjwa ya zinaa?
33.1 Kitanzi
1
33.2 Vidonge
2
33.3 Mpira wa kiume/kike
3
33.4 Njia za asili
4
34
35
36
34. Je ulishawahi kupata mimba?
Kama hapana nenda nambari 36
NDIYO
1
HAPANA
2
37
35. Kama ndiyo ulikuwa na umri gani?
38
miaka
36. Je ulipanga kupata mimba hiyo?
NDIYO
HAPANA
1
2
37. Je unawezaje kuzuia mimba na magonjwa ya kuambukiza?
37.1 Kuachana na tendo la ngono
1
37.2 Kutumia dawa za kuzuia mimba
2
37.3 Kupima afya mara kwa mara
3
37.4 Kuwa na mpenzi mmoja wa ngono
4
37.5 Mengineyo
5
(eleza)………………………………..
38. Kwa mawazo yako, ni umri upi ni hatari kwa msichana kupata
mimba?
38.1 Miaka 20
1
38.2 Miaka 18
2
38.3 Miaka 17
3
39
40
41
6
38.4 Miaka 16
4
38.5 Miaka15
5
38.6 Miaka 14
6
38.7 Miaka13
7
39. Ni umri upi unafaa kwa msichana kupata mimba?
39.1 Miaka 20 au zaidi
1
39.2 Miaka 18
2
39.3 Miaka 17
3
39.4 Miaka 16
4
39.5 Miaka 15
5
39.6 Miaka 14
6
39.7 Miaka 13 au chini zaidi
7
40. Ni matatizo gani ambayo msichana anaweza kupata akiwa na
mimba katika umri mdogo? Jibu yote
NDIYO
HAPANA
1
2
40.1 Mapigo ya damu kupanda
40.2 Kuharibika mimba changa
40.3 Kuanza uchungu kabla ya wakati
40.4 Magonjwa ya zinaa na ukimwi
40.5 Kuchanganyikiwa
40.6 Upungufu wa damu
40.7 Mengineyo
41. Ni matatizo yapi ya kijamii yanayoweza kumpata msichana mwenye
mimba?
NDIYO
HAPANA
1
2
41.1 Kukosa matumizi
41.2 Kutelekezwa na wazazi
41.3 Kukimbiwa na marafiki
41.4 Kupata aibu
41.5 Mengineyo
42
43
44
SEHEMU C: UPATIKANAJI WA HABARI
42. Ni nani aliyekuelimisha kuhusu masuala ya kimapenzi (ujinsia)?(jibu
yote)
ZAIDI
KIASI
HAPANA
1
2
3
42.1 Shule
42.2 Wazazi
42.3 Marafiki
42.4 Runinga/video
42.5 Magazeti/Vijarida
45
7
42.6 Mtandao
42.7 Kanisani/Msikitini
42.8 Njia nyinginezo (taja)………………..
43. Ni wapi ulipata habarí kuhusu masuala ya mimba?
ZAIDI
KIASI
HAPANA
1
2
3
43.1 Shuleni
43.2 Wazazi
43.3 Marafiki
43.4 Runinga/video
43.5 Magazeti/Vijarida
43.6 Mtandao
43.7 Kanisani/Msikitini
43.8 Kwingineko (taja)…
44. Je unapendekeza elimu ya ujinsia/uzazi zifundishwe wakati gani?
44.1 Elimu ya msingi (darasa……………………..)
1
44.2 Elimu ya sekondari (……………………)
2
44.3 Elimu ya juu
3
45. Je unataarifa juu ya sheria ya utoaji mimba nchini kwetu?
45.1 Ndiyo
1
45.2 Hapana
2
46. Kama ni ndiyo nani alikujulisha?
46.1 Shuleni
1
46.2 Kanisai/Msikitini
2
46.3 Marafiki
3
46.4 Radio
46.5 Magazeti
4
5
46.6 Runinga
6
46.7 Wengineo (taja)….
7
47. Je wewe unadhani msichana wa miaka 10-19 aruhusiwe kutoa
mamba?
NDIYO
HAPANA
1
2
48. Je wewe binafsi umeshawahi kutoa mimba?
(Kama ni hapana nenda nambari 50)
NDIYO
HAPANA
1
2
49. Kama ndiyo taja mahali ilipotolewa
49.1 Nyumbani
49.2 Hospitali/kliniki
49.3 Mtaani
49.4 Kwingineko (taja)
1
2
3
4
46
47
48
49
50
51
52
8
50. Je ulijisikiaje/ulijionaje wakati ulipotoa mimba?
………………………………………………………………….
…………………………………………………………………….
……………………………………………………………………
53
SEHEMU D: ATHARI ZA MIMBA KATIKA UMRI MDOGO
51. Kwa maneno yako mwenyewe, elezea athari/madhara ya kubeba
mimba isiyotarajiwa katika umri mdogo.
…………………………………………………………………………………
………………………………………………………………………………..
…………………………………………………………………………………
52. Wewe utazuiaje kubeba mimba isiyotarajiwa?
52.1 Kuacha kufanya tendo la ngono
54
1
55
52.2 Kutumia mpira wa kiume/kike
2
52.3 Kufuata mila/desturí (taja)
3
52.4 Mengineyo (taja)
4
53. Andika mambo ambayo ungependa kufahamu/kujifunza zaidi:
53.1
53.2
53.3
53.4
53.5
1
2
3
4
5
56
AHSANTE KWA USHIRIKIANO WAKO WA KUJAZA DODOSO HII
1
Annexure D
QUESTIONNAIRE
Factors contributing to the high adolescent pregnancy rate at Kinondoni municipal
council, Dar-es-Salaam, Tanzania
Answer each question by placing an “v” in the appropriate box or write down your response in
the space provided.
Number of questionnaire
1.
2
3
SECTION A: BIOGRAPHIC INFORMATION
OFFICE USE
4
1. Your age at your last birthday.
YEARS
2. Where do you live?
……………………………………………
5
3. Indicate your religion/faith.
3.1
Moslem
3.2
Protestant
3.3
Catholic
3.4
Other (specify)
......................................................................................
4. What is your tribe?
1
2
3
4
6
7
………………………………...........
8
5. Have you attended formal education?
YES
1
6. If Yes what is your level of education?
6.1 Primary education (standard…..)
6.2 Secondary education (Form………)
7
Whom do you live with?
7.1
Both parents
7.2
Father only
NO
2
9
1
2
1
2
2
OFFICE USE
7.3
7.4
7.5
7.6
Mother only
Husband
Guardian/adoptive parents
No permanent place (state where)
...........................................
Highest level of education of parents/guardian.
Father
Mother Guardian
8.1
No formal education
8.2
Primary school
•
Standard……..
8.3
Secondary school
•
Form………….
8.4
Higher education
9
Indicate your marital status.
9.1
Single
9.2
Divorced
9.3
Married
9.4
Widowed
9.5
Co-habiting
10
If married, state the circumstances.
10.1 Forced by parents
10.2 Voluntary
10.3 Dependency
10.4 Pregnancy
10.5 Other (specify)
........................................................................................
11
What is your Father’s/Guardian’s occupational status?
11.1 Unemployed
11.2 Employed
11.3 Self employed (Doing Business)
12 What is your Mother’s/Guardian’s occupational status?
12.1 Unemployed
12.2 Employed
12.3 Self-employed (Doing Business)
13
What is your occupation?
Please state
...........................................................................................
14 Does your occupation sustain your needs/life?
3
4
5
6
10
8
YES
1
1
11
2
3
4
1
2
3
4
5
1
2
3
4
5
1
2
3
1
2
3
12
13
14
15
16
NO
2
17
3
SECTION B: SEXUALITY AND REPRODUCTIVE HEALTH ISSUES
OFFICE USE
15
What physical changes do girls notice during puberty? (Please
specify).
15.1 Growth of pubic
1
15.2 Breasts develop
2
15.3 Starting of menstruation
3
15.4 Other (please state)
4
16
Have you had your menstrual period?
YES
NO
1
2
17. If yes how old were you when you had the first menstrual period?
17.1 8 years
17.2 9 years
17.3 10 years
17.4 11 years
17.5 12 years
17.6 13 years
17.7 Other (please specify) ................................................................
18. What information did you receive regarding the menstrual period?
(please list)
18.1 It is a curse
18.2 It is painful
18.3 You are ready to have a baby
18.4 You are ready to get married
18.5 About hygiene
18.6 Avoiding sexual intercourse
18.7 Other (please state)
19. Who supplied the information?
Source
YES
19.1 Mother
1
19.2 Father
1
19.3 Teacher
1
19.4 Nurse
1
19.5 Friends
1
19.6 Other relatives
1
19.7 Magazines
1
19.8 Books
1
19.9 Other (please specify)..................................................
1
20. When is a woman likely to get pregnant?
20.1 14 days before menstruation
20.2 14 days after menstruation
20.3 During menstruation
20.4 Anytime
1
2
3
4
5
6
7
1
2
3
4
5
6
7
NO
2
2
2
2
2
2
2
2
2
1
2
3
4
18
19
20
21
22
23
4
OFFICE USE
21. Have you ever had sexual intercourse?
24
YES
NO
If “NO” skip to question no. 27
25
22. At what age was your first sexual intercourse?
Years
23. What led you to have sexual intercourse?
23.1 Self desire
23.2 Peer pressure
23.3 Parent pressure
23.4 Pressure of partner
23.5 To get pregnant
23.6 Other ( reasons) ......................................................................
1
2
3
4
5
6
24. What was the age of your sexual partner at the first sexual
encounter?
years
26
27
25. How many sexual partners do you currently have?
28
26. How many sexual partners have you had?
29
27. What are the risks/dangers of indulging in sexual intercourse at an
early age?
27.1 Fail at school
1
27.2 Become pregnant
2
27.3 Contract STI/HIV/AIDS
3
27.4 Pushed out of the community
4
28. Do you use any contraceptives?
YES
NO
1
2
29. If yes, indicate the method :
29.1 Pills
1
29.2 Injectables
2
29.3 Traditional contraceptives
3
29.4 Other (please state)
4
..............................................................................
30
31
32
5
OFFICE USE
30. If no, state the reasons (please list):
........................................................................................................
........................................................................................................
........................................................................................................
31. Which type of contraceptive is suitable for teenagers?
31.1 Voluntary Surgical Contraception
31.2 Pills
31.3 Injectables
31.4 Condoms
32. Where are contraceptives available?
32.1 In shops (pharmacy)
32.2 Market place
32.3 Reproductive and child health clinic
32.4 At schools
32.5 Others (specify)
.......................................................................................
33. Which contraceptive method prevents pregnancy and sexually
transmitted diseases?
33.1 Intra Uterine Device
33.2 Pills
33.3 Condom
33.4 Natural method/rhythm
34. Have you been pregnant before?
If No skip to question no.37
YES
1
35. If yes, how old were you at your first pregnancy?
33
1
2
3
4
1
2
3
4
5
1
2
3
4
NO
2
Years
34
35
36
37
38
36. Was this a planned pregnancy?
YES
NO
1
2
37. How would you prevent pregnancy, sexually transmitted diseases and
HIV/AIDS?
37.1 By abstaining from sexual activities
1
37.2 Using contraceptives
2
37.3 Having regular medical check-ups
3
37.4 Have only one sexual partner
4
37.5 Other (please specify)
5
............................................................................
39
40
6
OFFICE USE
38. In your opinion, what is the youngest age at which you consider it a
risk to fall pregnant?
38.1 20 years
1
38.2 18 years
2
38.3 17 years
3
38.4 16 years
4
38.5 15 years
5
38.6 14 years
6
38.7 13 years and younger
7
39. What is the most appropriate age to fall pregnant?
39.1 20 years and older
1
39.2 18 years
2
39.3 17 years
3
39.4 16 years
4
39.5 15 years
5
39.6 14 years
6
39.7 13 years and younger
7
40. What health problems could be expected when an adolescent falls
pregnant?
Problems
YES NO
40.1 High blood pressure
1
2
40.2 Miscarriage
1
2
40.3 Premature labour
1
2
40.4 STI/HIV infection
1
2
40.5 Depression
1
2
40.6 Anaemia
1
2
40.7 Other:
1
2
41. What social problems are prevalent with an adolescent pregnancy?
Problems
YES NO
41.1 Lack of money
1
2
41.2 Parents will abandon me
1
2
41.3 My friends will abandon me
1
2
41.4 Shame
1
2
41.5 Other (please specify)
1
2
....................................................................
41
42
43
44
7
SECTION C: SOURCE OF INFORMATION
OFFICE
USE
42. Who provided you with the most information about sexuality and
reproduction?
Most Least None
1
2
3
42.1 School
42.2 Parents
42.3 Friends
42.4 Television/video
42.5 Newspapers/magazines
42.6 Internet
42.7 Church/mosque
42.8 Other (specify)
..........................................................
43. Who/what was the source of information about pregnancy?
Most Least None
1
2
3
43.1 School
43.2 Parents
43.3 Friends
43.4 Television/video
43.5 Newspapers/magazines
43.6 Internet
43.7 Church/mosque
43.8 Other (specify)
............................................................
44. When do you recommend should a girl be given information about
reproductive health?
44.1 Primary school
1
•
Standard
44.2 Secondary school
2
•
Form
44.3 Higher education
3
45. Are you aware of abortion laws?
44.1 Yes
1
44.2 No
2
46. If yes, who informed you?
46.1 School
1
46.2 Church
2
46.3 Friends
3
46.4 Radio
4
46.5 Magazines
5
46.6 Television
6
45
46
47
48
8
46.7 Other (please state)
...................................................................................
7
49
YES
1
NO
2
50
YES
1
NO
2
51
47. Do you think girls 10-19 years should have legal abortion?
48. Have you undergone an abortion? (If No go to no.50)
49. If yes, where (please indicate)?
49.1 At home
1
49.2 At a clinic
2
49.3 Backstreet
3
49.4 Other (please specify) ...............................................
4
50. How did you feel about the abortion?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
52
53
9
SECTION D: EFFECTS OF PREGNANCY ON THE ADOLESCENT
OFFICE USE
51. In your own words, describe the consequences of an unwanted
pregnancy.
..................................................................................................................
..................................................................................................................
..................................................................................................................
..................................................................................................................
..................................................................................................................
..................................................................................................................
52. How would you prevent an unwanted pregnancy?
52.1 Abstinence
52.2 Condom
52.3 Cultural practices (please state)
......................................................
52.4 Other (please state)
.........................................................................
53. I would like to have more knowledge about:
53.1
53.2
53.3
53.4
53.5
1
2
3
54
55
4
1
2
3
4
5
56
THANK YOU FOR YOUR ASSISTANCE IN COMPLETING THIS QUESTIONNAIRE